Provider Demographics
NPI:1255343133
Name:JOHNSON, ALFRED R (DO)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 HAMPSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-8105
Mailing Address - Country:US
Mailing Address - Phone:972-479-0400
Mailing Address - Fax:972-479-9435
Practice Address - Street 1:997 HAMPSHIRE LN
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-8105
Practice Address - Country:US
Practice Address - Phone:972-479-0400
Practice Address - Fax:972-479-9435
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8525207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00936JMedicare ID - Type Unspecified
TXA67203Medicare UPIN