MEDICARE: JOHN W JOHNSON III 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	208800000X	Urology Physician	G0910	TX

General Provider Information

NPI Number	:	1982749164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN W JOHNSON III MD

Provider Business Mailing Address
First Line	:	6100 HARRIS PKWY STE 225
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4126
Country	:	US
Telephone Number	:	817-346-5151
Fax Number	:	817-346-5234

Provider Business Practice Location Address
First Line	:	6100 HARRIS PKWY STE 225
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4126
Country	:	US
Telephone Number	:	817-346-5151
Fax Number	:	817-346-5234

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	08/31/2011

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