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NPI Code Detail

MEDICARE: JACK ALSTON JOHNSON MD

MEDICARE: JACK ALSTON 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
1207P00000XEmergency Medicine PhysicianR9985TX

General Provider Information

NPI Number : 1881129419
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK ALSTON JOHNSON MD
Provider Business Mailing Address
First Line : 6451 BRENTWOOD STAIR RD STE 200
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-3200
Country : US
Telephone Number : 817-496-9700
Fax Number :
Provider Business Practice Location Address
First Line : 2300 LONE STAR RD
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-8744
Country : US
Telephone Number : 877-847-9355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2017
Last Update Date : 11/06/2020

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