Healthcare Provider Details

I. General information

NPI: 1679731970
Provider Name (Legal Business Name): CHERYL K. JOHNSON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12121 RICHMOND AVE STE 226
HOUSTON TX
77082-2454
US

IV. Provider business mailing address

12121 RICHMOND AVE STE 226
HOUSTON TX
77082-2454
US

V. Phone/Fax

Practice location:
  • Phone: 281-597-0991
  • Fax: 281-597-0470
Mailing address:
  • Phone: 281-597-0991
  • Fax: 281-597-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS ANNE T TRA
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 281-340-8100