Provider Demographics
NPI:1861613606
Name:ROBERT K JOHNSON MD PA & ASSOCIATES
Entity type:Organization
Organization Name:ROBERT K JOHNSON MD PA & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-736-3126
Mailing Address - Street 1:401 W SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2815
Mailing Address - Country:US
Mailing Address - Phone:210-736-3126
Mailing Address - Fax:210-733-1953
Practice Address - Street 1:401 W SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2815
Practice Address - Country:US
Practice Address - Phone:210-736-3126
Practice Address - Fax:210-733-1953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1687208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE80949Medicare UPIN