MEDICARE: MR. JEFFREY DON JOHNSON CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	595335	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00C44S	OTHER	TX	BCBS GROUP #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	84214U	OTHER	TX	BCBS IND. PROV. #

General Provider Information

NPI Number	:	1033114970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY DON JOHNSON CRNA

Provider Business Mailing Address
First Line	:	PO BOX 1827
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76804-1827
Country	:	US
Telephone Number	:	325-641-2655
Fax Number	:	325-641-0992

Provider Business Practice Location Address
First Line	:	310 S PECOS ST
Second Line	:
City	:	COLEMAN
State	:	TX
Zip	:	76834-4159
Country	:	US
Telephone Number	:	325-793-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	02/20/2009

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