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1598741878

NPI Code Detail

MEDICARE: DR. VANESSA L JOHNSON MD

MEDICARE: DR. VANESSA L 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
1	207P00000X	Emergency Medicine Physician	K8235	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	930088131	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	930078716	OTHER	TX	RAILROAD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8253J5	OTHER	TX	BCBS
4	86798N	OTHER	TX	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598741878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANESSA L JOHNSON MD

Provider Business Mailing Address
First Line	:	PO BOX 201606
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-1606
Country	:	US
Telephone Number	:	972-758-3523
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 8TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3902
Country	:	US
Telephone Number	:	972-758-3523
Fax Number	:

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	09/23/2009

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Directions to “ DR. VANESSA L JOHNSON MD” Practice Location

Language	Start Address	Practice Location

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