Provider Demographics
NPI:1902898075
Name:JOHNSON, HOWARD R (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:R
Last Name:JOHNSON
Suffix:
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 1:540 W. 15TH STREET
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045
Mailing Address - Country:US
Mailing Address - Phone:806-364-7512
Mailing Address - Fax:806-364-5256
Practice Address - Street 1:540 W. 15TH STREET
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045
Practice Address - Country:US
Practice Address - Phone:806-364-7512
Practice Address - Fax:806-364-5256
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128686601Medicaid
C17484Medicare UPIN
TX128686601Medicaid