Provider Demographics
NPI:1982749164
Name:JOHNSON, JOHN W III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6100 HARRIS PKWY STE 225
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4126
Mailing Address - Country:US
Mailing Address - Phone:817-346-5151
Mailing Address - Fax:817-346-5234
Practice Address - Street 1:6100 HARRIS PKWY STE 225
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4126
Practice Address - Country:US
Practice Address - Phone:817-346-5151
Practice Address - Fax:817-346-5234
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0910208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD97431Medicare UPIN
TX0A5880Medicare Oscar/Certification