MEDICARE: DR. JENNIFER LAVETTE JOHNSON-CALDWELL MD

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	207R00000X	Internal Medicine Physician	K5571	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

General Provider Information

NPI Number	:	1093711269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LAVETTE JOHNSON-CALDWELL MD

Provider Business Mailing Address
First Line	:	1315 ST JOSEPH PKWY
Second Line	:	SUITE 140
City	:	HOUSTON
State	:	TX
Zip	:	77002-8233
Country	:	US
Telephone Number	:	713-520-8963
Fax Number	:	713-523-6941

Provider Business Practice Location Address
First Line	:	1315 ST JOSEPH PKWY
Second Line	:	SUITE 140
City	:	HOUSTON
State	:	TX
Zip	:	77002-8233
Country	:	US
Telephone Number	:	713-520-8963
Fax Number	:	713-523-6941

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/28/2022

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