Provider Demographics
NPI:1992091326
Name:JOHNSON, WEILAN ZUO (MD)
Entity type:Individual
Prefix:
First Name:WEILAN
Middle Name:ZUO
Last Name:JOHNSON
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 1:700 SAN GABRIEL VILLAGE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-5594
Mailing Address - Country:US
Mailing Address - Phone:512-819-9910
Mailing Address - Fax:512-819-9970
Practice Address - Street 1:700 SAN GABRIEL VILLAGE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5594
Practice Address - Country:US
Practice Address - Phone:512-819-9910
Practice Address - Fax:512-819-9970
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8919207N00000X
CAA123109207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8124NNOtherBCBS PV#