Provider Demographics
NPI:1285088104
Name:JOHNSON-MINTER, JACQUELYN (MD)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:JOHNSON-MINTER
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 1:55 STERLING ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2935
Mailing Address - Country:US
Mailing Address - Phone:281-851-4962
Mailing Address - Fax:
Practice Address - Street 1:55 STERLING ST
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2935
Practice Address - Country:US
Practice Address - Phone:281-851-4962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-17
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ80042083P0901X
AL186862083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine