MEDICARE: DR. CRAIG DAVID JOHNSON M.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	207RG0100X	Gastroenterology Physician	D9191	TX

General Provider Information

NPI Number	:	1629163571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG DAVID JOHNSON M.D.

Provider Business Mailing Address
First Line	:	4801 WOODWAY DR
Second Line	:	SUITE 369W
City	:	HOUSTON
State	:	TX
Zip	:	77056-1884
Country	:	US
Telephone Number	:	713-791-1800
Fax Number	:	713-791-1502

Provider Business Practice Location Address
First Line	:	4801 WOODWAY DR
Second Line	:	SUITE 369W
City	:	HOUSTON
State	:	TX
Zip	:	77056-1884
Country	:	US
Telephone Number	:	713-791-1800
Fax Number	:	713-791-1502

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	12/28/2016

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