MEDICARE: MR. BRIAN S JOHNSON NP

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	363L00000X	Nurse Practitioner	664213	TX

General Provider Information

NPI Number	:	1205875309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN S JOHNSON NP

Provider Business Mailing Address
First Line	:	PO BOX 47154
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78265-7154
Country	:	US
Telephone Number	:	210-401-8185
Fax Number	:	210-401-8186

Provider Business Practice Location Address
First Line	:	22250 BULVERDE RD
Second Line	:	STE 120
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261-3084
Country	:	US
Telephone Number	:	210-401-8185
Fax Number	:	210-401-8186

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	12/13/2013

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