Healthcare Provider Details

I. General information

NPI: 1336253590
Provider Name (Legal Business Name): BOBBY JOHNSON JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 DEER RIDGE DR
ROUND ROCK TX
78681-5515
US

IV. Provider business mailing address

301 PRAIRIE OAK CT
BURLESON TX
76028-2281
US

V. Phone/Fax

Practice location:
  • Phone: 512-766-1400
  • Fax:
Mailing address:
  • Phone: 817-707-4235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberL8749
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: