Healthcare Provider Details

I. General information

NPI: 1699918342
Provider Name (Legal Business Name): MEGAN ELIZABETH JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN ELIZABETH HERCEG M.D

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 WELBORN ST
DALLAS TX
75219-3924
US

IV. Provider business mailing address

2222 WELBORN ST
DALLAS TX
75219-3924
US

V. Phone/Fax

Practice location:
  • Phone: 214-559-5000
  • Fax: 214-443-7309
Mailing address:
  • Phone: 214-559-5135
  • Fax: 214-443-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD48266
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMD48266
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberP9226
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: