Healthcare Provider Details

I. General information

NPI: 1407102890
Provider Name (Legal Business Name): DR JOHNSON FOOT PRINTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 HIGHWAY 90A EAST
RICHMOND TX
77469
US

IV. Provider business mailing address

117 HIGHWAY 90A EAST
RICHMOND TX
77469
US

V. Phone/Fax

Practice location:
  • Phone: 281-342-8700
  • Fax:
Mailing address:
  • Phone: 281-342-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number1940
License Number StateTX

VIII. Authorized Official

Name: DR. ALICIA L JOHNSON
Title or Position: OWNER
Credential: DPM
Phone: 281-342-8700