Provider Demographics
NPI:1255347340
Name:JOHNSON, RALEIGH FRANCIS III (MD)
Entity type:Individual
Prefix:DR
First Name:RALEIGH
Middle Name:FRANCIS
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 DELAWARE ST STE 209
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3059
Mailing Address - Country:US
Mailing Address - Phone:409-899-3682
Mailing Address - Fax:
Practice Address - Street 1:3560 DELAWARE ST STE 209
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3059
Practice Address - Country:US
Practice Address - Phone:409-899-3682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020108152085R0202X
TXL10842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149233001Medicaid
MO185214OtherMO BLUE CROSS BLUE SHIELD
524893OtherHEALTHLINK
MO205919806Medicaid
TXL1084OtherMEDICAL LICENSE
430954380CAPOtherMERCY HEALTH PLAN
IL036-107490OtherIL BLUE CROSS BLUE SHIELD
063896OtherHEALTH ALLIANCE
TX60117868OtherDPS
TX60117868OtherDPS
TX60117868OtherDPS
IL300134628Medicare ID - Type UnspecifiedIL RAILROAD MEDICARE
ILL94966Medicare ID - Type UnspecifiedIL MEDICARE
063896OtherHEALTH ALLIANCE
MO153310002Medicare PIN
MO185214OtherMO BLUE CROSS BLUE SHIELD
H66717Medicare UPIN
MO022010086Medicare ID - Type UnspecifiedMO MEDICARE
AR149233001Medicaid