MEDICARE: DR. ROBERT MARSHALL JOHNSON D.P.M.

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	213ES0131X	Foot Surgery Podiatrist	0722	TX

General Provider Information

NPI Number	:	1376531889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT MARSHALL JOHNSON D.P.M.

Provider Business Mailing Address
First Line	:	4763 BARWICK DR
Second Line	:	SUITE 101
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1500
Country	:	US
Telephone Number	:	817-370-2895
Fax Number	:	817-370-6278

Provider Business Practice Location Address
First Line	:	4763 BARWICK DR
Second Line	:	SUITE 101
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1500
Country	:	US
Telephone Number	:	817-370-2895
Fax Number	:	817-370-6278

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	07/08/2007

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