MEDICARE: DR. ANTHONY EUGENE 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	70680	CA
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	Q2309	TX
3	207X00000X	Orthopaedic Surgery Physician	70680	CA

General Provider Information

NPI Number	:	1700875176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY EUGENE JOHNSON MD

Provider Business Mailing Address
First Line	:	3851 ROGER BROOKE DR
Second Line	:	BAMC ORTHOPAEDIC SURGERY
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-4501
Country	:	US
Telephone Number	:	210-916-5666
Fax Number	:	210-916-0559

Provider Business Practice Location Address
First Line	:	3851 ROGER BROOKE DR
Second Line	:	BAMC ORTHOPAEDIC SURGERY
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-4501
Country	:	US
Telephone Number	:	210-916-5666
Fax Number	:	210-916-0559

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	09/19/2017

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