Provider Demographics
NPI:1063590248
Name:JOHNSON, RUPERT E (RN BED)
Entity type:Individual
Prefix:MR
First Name:RUPERT
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RN BED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 SOUTHWEST FWY
Mailing Address - Street 2:STE. 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1126
Mailing Address - Country:US
Mailing Address - Phone:281-207-5338
Mailing Address - Fax:281-207-5339
Practice Address - Street 1:4800 SUGAR GROVE BLVD
Practice Address - Street 2:STE. 290
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2635
Practice Address - Country:US
Practice Address - Phone:281-207-5338
Practice Address - Fax:281-207-5339
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0074527171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5080980001Medicare NSC