MEDICARE: DR. JASON DEAN JOHNSON 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	207Q00000X	Family Medicine Physician	P0909	TX
2	207QS0010X	Sports Medicine (Family Medicine) Physician	036100533	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00406743	OTHER		MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	216741895001	OTHER	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295727410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON DEAN JOHNSON MD

Provider Business Mailing Address
First Line	:	4515 SETON CENTER PARKWAY
Second Line	:	SUITE 215-CREDENTIALING
City	:	AUSTIN
State	:	TX
Zip	:	78755-0726
Country	:	US
Telephone Number	:
Fax Number	:	512-406-6216

Provider Business Practice Location Address
First Line	:	1807 W SLAUGHTER LN STE 490
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-6208
Country	:	US
Telephone Number	:	512-282-8967
Fax Number	:	512-292-5125

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	03/09/2016

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Directions to “ DR. JASON DEAN JOHNSON MD” Practice Location

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