MEDICARE: CRAIG D. JOHNSON, M.D., P.A.

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	207RG0100X	Gastroenterology Physician	D9191	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	:	1255631909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAIG D. JOHNSON, M.D., P.A.

Provider Business Mailing Address
First Line	:	6560 FANNIN ST
Second Line	:	SUITE 1625
City	:	HOUSTON
State	:	TX
Zip	:	77030-2761
Country	:	US
Telephone Number	:	713-791-1800
Fax Number	:	713-791-1502

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST
Second Line	:	SUITE 1625
City	:	HOUSTON
State	:	TX
Zip	:	77030-2761
Country	:	US
Telephone Number	:	713-791-1800
Fax Number	:	713-791-1502

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CRAIG DAVID JOHNSON
Credential	:	M.D.
Telephone Number	:	713-791-1800

Provider Enumeration Date	:	10/28/2010
Last Update Date	:	10/28/2010

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Directions to “CRAIG D. JOHNSON, M.D., P.A. ” Practice Location

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