NPIMap

Organization Active NPI

Jack L. Johnson Jr., M.D., P.a.

  • Family Medicine Physician
  • Lewisville, TX
National Provider Identifier
1912165218
Registry record updated Nov 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
H5576 Issued in TX
Legal business name
JACK L. JOHNSON JR., M.D., P.A.
Practice address
560 W Main St
Suite 100
Lewisville, TX 75057-3629
Phone
(972) 436-9797
Fax
(972) 436-9790
NPI assigned
May 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jack L. Johnson Jr., M.D.
Title
Owner/Physician
Phone
(972) 436-9797

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X H5576 TX Primary

Addresses

Primary practice location

560 W Main St
Suite 100
Lewisville, TX 75057-3629

Mailing address

560 W Main St
Suite 100
Lewisville, TX 75057-3629
Phone (972) 436-9797

Other identifiers 1

IdentifierTypeStateIssuer
0047LPOtherTXBCBS

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227225600000",
    "number": "1912165218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 W MAIN ST",
            "address_2": "SUITE 100",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750573629",
            "telephone_number": "972-436-9797",
            "fax_number": "972-436-9790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 W MAIN ST",
            "address_2": "SUITE 100",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750573629",
            "telephone_number": "972-436-9797",
            "fax_number": "972-436-9790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK L. JOHNSON JR., M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-23",
        "last_updated": "2008-11-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "972-436-9797",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "H5576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0047LP",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewisville, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.