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NPI Code Detail

MEDICARE: JAKEEN WILLIAMS JOHNSON MD

MEDICARE: JAKEEN WILLIAMS JOHNSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianM1404TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295821486
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAKEEN WILLIAMS JOHNSON MD
Provider Business Mailing Address
First Line : 11511 SHADOW CREEK PKWY
Second Line :
City : PEARLAND
State : TX
Zip : 77584-7298
Country : US
Telephone Number : 713-442-0000
Fax Number :
Provider Business Practice Location Address
First Line : 25553 US HIGHWAY 59
Second Line :
City : PORTER
State : TX
Zip : 77365-5500
Country : US
Telephone Number : 713-442-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2006
Last Update Date : 06/09/2021

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