Provider Demographics
NPI:1114033776
Name:JOHNSON, ESTHER YVONNE (MD)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:YVONNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY
Mailing Address - Street 2:SUITE 135
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3544
Mailing Address - Country:US
Mailing Address - Phone:806-761-0333
Mailing Address - Fax:806-722-2908
Practice Address - Street 1:5520 4TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4220
Practice Address - Country:US
Practice Address - Phone:806-761-0475
Practice Address - Fax:806-793-0693
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD34605208000000X
TXN6393208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD169291400Medicaid
D78086Medicare UPIN
MD432241400Medicare ID - Type Unspecified