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General NPI Number Information
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NPI Number | 1730475815
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Entity Type | Individual
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Provider Name | MARC EDWARD JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 1350 S MAIN ST STE 1600
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City | FORT WORTH
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State | TX
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Zip | 76104-7663
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Country | US
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Telephone | 817-702-3701
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 S MAIN ST STE 1600
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City | FORT WORTH
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State | TX
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Zip | 76104-7663
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Country | US
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Telephone | 601-695-0397
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23972
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E8843
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | S-7461
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License Number State | TX
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