Provider Demographics
NPI:1194872564
Name:DANIEL H. JOHNSON, JR., M.D.
Entity type:Organization
Organization Name:DANIEL H. JOHNSON, JR., M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:504-885-4223
Mailing Address - Street 1:3100 CLEARVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5304
Mailing Address - Country:US
Mailing Address - Phone:504-885-4223
Mailing Address - Fax:504-887-6620
Practice Address - Street 1:3100 CLEARVIEW PKWY
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5304
Practice Address - Country:US
Practice Address - Phone:504-885-4223
Practice Address - Fax:504-887-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA57883Medicaid
LA57883Medicaid