Active NPI
Jerry L Johnson MD PA
- Obstetrics & Gynecology Physician
- Lufkin, TX
National Provider Identifier
1174824510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- J2117
- Legal business name
- JERRY L JOHNSON MD PA
- Practice address
- 503 S John Redditt Dr
Lufkin, TX 75904-3120 - Phone
- (936) 632-1533
- Fax
- (936) 632-1726
- NPI assigned
- Nov 16, 2010
- Last updated
- Sep 6, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jerry L Johnson, MD
- Title
- MD/Owner
- Phone
- (936) 632-1533
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | J2117 | TX | Primary |
Addresses
Primary practice location
503 S John Redditt Dr
Lufkin, TX 75904-3120
Mailing address
503 S John Redditt Dr
Lufkin, TX 75904-3120
Phone (936) 632-1533
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Obstetrics & Gynecology Physician
- Lufkin, TX
- NPI 1487721858
-
- Women's Health Clinical Nurse Specialist
- Lufkin, TX
- NPI 1316297161
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1289865600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1346889600000",
"number": "1174824510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "503 S JOHN REDDITT DR",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759043120",
"telephone_number": "936-632-1533",
"fax_number": "936-632-1726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "503 S JOHN REDDITT DR",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759043120",
"telephone_number": "936-632-1533",
"fax_number": "936-632-1726"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JERRY L JOHNSON MD PA",
"organizational_subpart": "NO",
"enumeration_date": "2010-11-16",
"last_updated": "2012-09-06",
"status": "A",
"authorized_official_last_name": "JOHNSON",
"authorized_official_first_name": "JERRY",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "MD/OWNER",
"authorized_official_telephone_number": "936-632-1533",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology",
"state": "TX",
"license": "J2117",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lufkin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.