| Jack L. Johnson Jr., M.d., P.a. | |
|
560 W Main St Suite 100 Lewisville TX 75057-3629 | |
| (972) 436-9797 | |
| (972) 436-9790 |
| Full Name | Jack L. Johnson Jr., M.d., P.a. |
|---|---|
| Speciality | Family Medicine |
| Location | 560 W Main St, Lewisville, Texas |
| Authorized Official Name and Position | Jack L. Johnson (OWNER/PHYSICIAN) |
| Authorized Official Contact | 9724369797 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack L. Johnson Jr., M.d., P.a. 560 W Main St Suite 100 Lewisville TX 75057-3629 Ph: (972) 436-9797 | Jack L. Johnson Jr., M.d., P.a. 560 W Main St Suite 100 Lewisville TX 75057-3629 Ph: (972) 436-9797 |
| NPI Number | 1912165218 |
|---|---|
| Provider Enumeration Date | 05/23/2008 |
| Last Update Date | 11/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912165218 | NPI | - | NPPES |
| 0047LP | Other | TX | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | H5576 (Texas) | Primary |
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