Provider Demographics
NPI:1992979900
Name:WM. KENT JOHNSON, M.D., F.A.C.S., P.A.
Entity type:Organization
Organization Name:WM. KENT JOHNSON, M.D., F.A.C.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-893-2288
Mailing Address - Street 1:17203 RED OAK DR STE 103
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2612
Mailing Address - Country:US
Mailing Address - Phone:281-893-2288
Mailing Address - Fax:281-893-2882
Practice Address - Street 1:17203 RED OAK DR STE 103
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2612
Practice Address - Country:US
Practice Address - Phone:281-893-2288
Practice Address - Fax:281-893-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6320208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00662GOtherMEDICARE ID
TX00662GOtherMEDICARE ID