=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730492034
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANITRA JOHNSON MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2010
-----------------------------------------------------
Last Update Date | 07/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 251 MEDICAL CENTER BLVD STE 300
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77598-4242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-557-0300
-----------------------------------------------------
Fax | 281-557-3301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 251 MEDICAL CENTER BLVD STE 300
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77598-4242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-557-0300
-----------------------------------------------------
Fax | 281-557-3301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | ANITRA LYNNE JOHNSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 281-557-0300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------