Healthcare Provider Details

I. General information

NPI: 1962666479
Provider Name (Legal Business Name): SHAWN M. JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FERRY RD
GALVESTON TX
77550-3185
US

IV. Provider business mailing address

PO BOX 1912
GALVESTON TX
77553-1912
US

V. Phone/Fax

Practice location:
  • Phone: 409-766-4752
  • Fax:
Mailing address:
  • Phone: 409-766-4752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: