MEDICARE: DARRYL JOHNSON

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	207KI0005X	Clinical & Laboratory Immunology (Allergy & Immunology) Physician	N5626	TX

General Provider Information

NPI Number	:	1790107977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRYL JOHNSON

Provider Business Mailing Address
First Line	:	7457 HARWIN DR STE 210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-2024
Country	:	US
Telephone Number	:	832-573-9016
Fax Number	:

Provider Business Practice Location Address
First Line	:	7457 HARWIN DR STE 210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-2024
Country	:	US
Telephone Number	:	832-573-9016
Fax Number	:

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

Provider Enumeration Date	:	01/07/2014
Last Update Date	:	01/07/2014

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Directions to “ DARRYL JOHNSON ” Practice Location

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