MEDICARE: JOHAN JOSEPH VALLE DO

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	T4079	TX
2	207P00000X	Emergency Medicine Physician	125.074838	IL
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1942760418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHAN JOSEPH VALLE DO

Provider Business Mailing Address
First Line	:	2805 TALLOWOOD CT
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-3133
Country	:	US
Telephone Number	:	214-697-7338
Fax Number	:

Provider Business Practice Location Address
First Line	:	3318 W BUCKINGHAM RD
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75042-4300
Country	:	US
Telephone Number	:	954-939-5000
Fax Number	:

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

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	02/27/2026

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Directions to “ JOHAN JOSEPH VALLE DO” Practice Location

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