=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609927342
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAWN EVETTE JOHNSON M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 03/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3720 WESTHEIMER RD STE 601
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77027-5277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-463-1913
-----------------------------------------------------
Fax | 936-873-8647
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23390 PLANTATION LAKE DR
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77445-8013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-463-1913
-----------------------------------------------------
Fax | 936-873-8647
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | P3902
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | P3902
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 23310
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 0101252896
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | MD.205784
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------