MEDICARE: DR. DONALD ALFRED JOHNSON PH.D.

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
1	103T00000X	Psychologist	2-3353	TX

General Provider Information

NPI Number	:	1467599514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD ALFRED JOHNSON PH.D.

Provider Business Mailing Address
First Line	:	4601 SPICEWOOD SPRINGS RD
Second Line	:	BLDG. 4, STE. 200
City	:	AUSTIN
State	:	TX
Zip	:	78759-8598
Country	:	US
Telephone Number	:	512-467-1376
Fax Number	:	512-467-8658

Provider Business Practice Location Address
First Line	:	4601 SPICEWOOD SPRINGS RD
Second Line	:	BLDG. 4, STE. 200
City	:	AUSTIN
State	:	TX
Zip	:	78759-8598
Country	:	US
Telephone Number	:	512-467-1376
Fax Number	:	512-467-8658

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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