MEDICARE: DANE CHRISTIAN JOHNSON AA

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	367H00000X	Anesthesiologist Assistant

General Provider Information

NPI Number	:	1861439960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANE CHRISTIAN JOHNSON AA

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 S 31ST ST
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76508-1212
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	09/17/2020

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