Provider Demographics
NPI:1205875309
Name:JOHNSON, BRIAN S (NP)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 47154
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-7154
Mailing Address - Country:US
Mailing Address - Phone:210-401-8185
Mailing Address - Fax:210-401-8186
Practice Address - Street 1:22250 BULVERDE RD
Practice Address - Street 2:STE 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78261-3084
Practice Address - Country:US
Practice Address - Phone:210-401-8185
Practice Address - Fax:210-401-8186
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX664213363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q42400Medicare UPIN