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General NPI Number Information
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NPI Number | 1386919611
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Entity Type | Organization
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Legal Business Name | LARRY T JOHNSON MD
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 5701 MAPLE AVE 100
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City | DALLAS
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State | TX
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Zip | 75235-6519
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Country | US
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Telephone | 214-351-6600
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Fax | 214-351-5046
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Provider Business Mailing Address
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Address Line | 5701 MAPLE AVE 100
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City | DALLAS
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State | TX
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Zip | 75235-6519
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Country | US
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Telephone | 214-351-6600
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Fax | 214-351-5046
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | LISA CONTRERAS
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Credential |
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Telephone | 214-654-2129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | G6311
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License Number State | TX
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