Provider Demographics
NPI:1265416580
Name:JOHNSON, DENISE A (MD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 E FM 544 STE 112
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4080
Mailing Address - Country:US
Mailing Address - Phone:469-626-3215
Mailing Address - Fax:469-262-3117
Practice Address - Street 1:170 E FM 544 STE 112
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4080
Practice Address - Country:US
Practice Address - Phone:469-626-3215
Practice Address - Fax:469-626-3117
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138894401Medicaid
TX138894403Medicaid
TX138894411Medicaid
TX138894402Medicaid
TX138894407Medicaid
TX138894410Medicaid
TX138894412Medicaid
TX138894413Medicaid
TX138894408Medicaid
TX138894404Medicaid
TX138894405Medicaid
TX138894406Medicaid
TX8K0724OtherMEDICARE
TX138894406Medicaid
TX138894404Medicaid