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NPI Code Detail

MEDICARE: GREGORY LLOYD JOHNSON MD

MEDICARE: GREGORY LLOYD 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
12085R0202XDiagnostic Radiology Physician66469CT
22085R0202XDiagnostic Radiology Physician54635KY
32085R0202XDiagnostic Radiology Physician059314GA
42085R0202XDiagnostic Radiology PhysicianQ9645TX
52085R0202XDiagnostic Radiology Physician2005-01647NC
62085R0202XDiagnostic Radiology PhysicianMD00044283WA

General Provider Information

NPI Number : 1326025057
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY LLOYD JOHNSON MD
Provider Business Mailing Address
First Line : 2825 OAK LAWN AVE UNIT 192749
Second Line :
City : DALLAS
State : TX
Zip : 75219-4688
Country : US
Telephone Number : 510-683-9500
Fax Number : 877-880-2039
Provider Business Practice Location Address
First Line : 2825 OAK LAWN AVE UNIT 192749
Second Line :
City : DALLAS
State : TX
Zip : 75219-4688
Country : US
Telephone Number : 844-389-5711
Fax Number : 877-880-2039
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2005
Last Update Date : 11/19/2024

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