Provider Demographics
NPI:1063417368
Name:JOHNSON, TONE JR (MD,)
Entity type:Individual
Prefix:DR
First Name:TONE
Middle Name:
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 S ALAMEDA ST
Mailing Address - Street 2:STE A
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2555
Mailing Address - Country:US
Mailing Address - Phone:361-884-4131
Mailing Address - Fax:361-884-4171
Practice Address - Street 1:3138 S ALAMEDA ST
Practice Address - Street 2:STE A
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2555
Practice Address - Country:US
Practice Address - Phone:361-884-4131
Practice Address - Fax:361-884-4171
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121505501Medicaid
TX121505501Medicaid
TXC17493Medicare UPIN