Provider Demographics
NPI:1306812516
Name:JOHNSON, GLOVER OL JR (MD)
Entity type:Individual
Prefix:
First Name:GLOVER
Middle Name:OL
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10906 OLYMPIA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2629
Mailing Address - Country:US
Mailing Address - Phone:713-234-7390
Mailing Address - Fax:713-234-7336
Practice Address - Street 1:138 ELDRIDGE RD
Practice Address - Street 2:STE E
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4083
Practice Address - Country:US
Practice Address - Phone:713-234-7390
Practice Address - Fax:713-234-7336
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE2031207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN504748OtherWELLCARE
TX10019729OtherAMERIGROUP
TX4010529OtherAETNA
TX8H9486OtherBCBS
TX131117704Medicaid
TX183097000OtherTEXAS WORKER'S COMP
TX131117707Medicaid
TX1565261OtherLOUSIANA MEDICAID
TX609573OtherUNITED HEALTHCARE
TX609573OtherUNITED HEALTHCARE
TX8H9486OtherBCBS
TX1565261OtherLOUSIANA MEDICAID