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General NPI Number Information
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NPI Number | 1184606246
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Entity Type | Individual
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Provider Name | TERRY JOHNSON MD
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Gender | Male
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 07/14/2007
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Provider Practice Location Address
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Address Line | 1149 AMBLER AVE
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City | ABILENE
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State | TX
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Zip | 79601-2309
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Country | US
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Telephone | 325-676-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 1149 AMBLER AVE
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City | ABILENE
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State | TX
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Zip | 79601-2309
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | E4437
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License Number State | TX
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