Frederick C Johnson, DO | |
12221 Merit Dr, Suite 1610, Dallas, TX 75251-2202 | |
(214) 217-1911 | |
Not Available |
Full Name | Frederick C Johnson |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 12221 Merit Dr, Dallas, Texas |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1205851672 | NPI | - | NPPES |
8S2689 | Other | TX | BCBS |
164307406 | Medicaid | TX | |
23981741 | Medicaid | NM | |
164307403 | Medicaid | TX | |
164307404 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | L4474 (Texas) | Primary |
2080P0204X | Pediatrics - Pediatric Emergency Medicine | L4474 (Texas) | Secondary |
Entity Name | Pediatric Emergency Medicine Group, Llp |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1629448535 PECOS PAC ID: 9931409943 Enrollment ID: O20151124000478 |
Mailing Address | Practice Location Address |
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Frederick C Johnson, DO 7914 Enclave Way, Dallas, TX 75218-4502 Ph: (214) 263-1445 | Frederick C Johnson, DO 12221 Merit Dr, Suite 1610, Dallas, TX 75251-2202 Ph: (214) 217-1911 |
Dr. Jyothsna Gattineni, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 5323 Harry Hines Blvd, Dallas, TX 75390 Phone: 214-648-3438 | |
Ruth Osei Fordjour, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 12221 Merit Dr, Suite 1500, Dallas, TX 75251 Phone: 214-957-4754 | |
Dr. Alecia Curlene Nero, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 5323 Harry Hines Blvd, Dallas, TX 75390 Phone: 214-648-4180 | |
Dr. Sravani Avula, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 5323 Harry Hines Blvd, Dallas, TX 75390 Phone: 214-730-5437 | |
Asif Zia Khattak, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 3500 Gaston Ave, Dallas, TX 75246 Phone: 214-820-7604 | |
Sadia Malik, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 5323 Harry Hines Boulevard, Dallas, TX 75390 Phone: 214-456-2533 Fax: 214-456-8130 | |
Sana Jamil Siddiqui, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 5323 Harry Hines Boulevard, Dallas, TX 75390 Phone: 214-456-0488 Fax: 214-456-4486 |