Provider Demographics
NPI:1952580144
Name:JOHNSON, STEVEN (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
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 1:4002 S LOOP 256
Mailing Address - Street 2:SUITE G
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-8491
Mailing Address - Country:US
Mailing Address - Phone:903-723-2427
Mailing Address - Fax:903-723-2407
Practice Address - Street 1:3201 S LOOP 256 STE 630
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-6905
Practice Address - Country:US
Practice Address - Phone:903-723-0330
Practice Address - Fax:903-723-2407
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5390207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX325724YMAFOtherMEDICARE
TX752616977015OtherTRICARE
TX75-2616977-015OtherTRICARE
TX75-0818167-051OtherTRICARE