Healthcare Provider Details

I. General information

NPI: 1821105990
Provider Name (Legal Business Name): SCOTT JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7979 WURZBACH RD
SAN ANTONIO TX
78229-4427
US

IV. Provider business mailing address

UTHSCSA, UTHSCSA, DEPT. OF SURGERY 7703 FLOYD CURL DRIVE, RM 238F.3
SAN ANTONIO TX
78229
US

V. Phone/Fax

Practice location:
  • Phone: 210-257-1400
  • Fax:
Mailing address:
  • Phone: 210-567-5615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberJ4869
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: