Provider Demographics
NPI:1679731970
Name:CHERYL K. JOHNSON MD PA
Entity type:Organization
Organization Name:CHERYL K. JOHNSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-340-8100
Mailing Address - Street 1:12121 RICHMOND AVE STE 226
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2454
Mailing Address - Country:US
Mailing Address - Phone:281-597-0991
Mailing Address - Fax:281-597-0470
Practice Address - Street 1:12121 RICHMOND AVE STE 226
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2454
Practice Address - Country:US
Practice Address - Phone:281-597-0991
Practice Address - Fax:281-597-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0067PCOtherBCBS
TX0067PCOtherBCBS