Provider Demographics
NPI:1194929760
Name:JOHNSON, CLINT WESTON (MD)
Entity type:Individual
Prefix:
First Name:CLINT
Middle Name:WESTON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1526
Mailing Address - Country:US
Mailing Address - Phone:713-486-7500
Mailing Address - Fax:713-512-2234
Practice Address - Street 1:9305 PINECROFT DR STE 400
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3482
Practice Address - Country:US
Practice Address - Phone:713-486-8800
Practice Address - Fax:281-367-1323
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6392207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218709803Medicaid
TX8DJ311OtherBLUE CROSS BLUE SHIELD