MEDICARE: DR. OLENDRUFF LEREY JOHNSON M.D.

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	207R00000X	Internal Medicine Physician	G7248	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	:	1730186669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLENDRUFF LEREY JOHNSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 300969
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77230-0969
Country	:	US
Telephone Number	:	713-523-8300
Fax Number	:	713-523-8347

Provider Business Practice Location Address
First Line	:	7929 KIRBY DR STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1701
Country	:	US
Telephone Number	:	713-461-2915
Fax Number	:	713-474-8131

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/29/2021

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