MEDICARE: CHERYL K. JOHNSON MD PA

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	207QA0505X	Adult Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0067PC	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1679731970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHERYL K. JOHNSON MD PA

Provider Business Mailing Address
First Line	:	12121 RICHMOND AVE STE 226
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2454
Country	:	US
Telephone Number	:	281-597-0991
Fax Number	:	281-597-0470

Provider Business Practice Location Address
First Line	:	12121 RICHMOND AVE STE 226
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2454
Country	:	US
Telephone Number	:	281-597-0991
Fax Number	:	281-597-0470

Authorized Official
Title or Position	:	ACCOUNT MANAGER
Name	:	MISS ANNE T TRA
Credential	:
Telephone Number	:	281-340-8100

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	02/05/2009

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