| Organization Name: | J. DAVID JOHNSON,MD,PA |
| NPI Number: | 1376747196 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES M GORDON (OFC MGR) |
| Mailing Address: | 618 S Broadway Ave Tyler |
| State: | TX US |
| Postal Code: | 757011665 |
| Phone Number: | 9035969900 |
| Fax Number: | 9035960242 |
| NPI Enumeration Date: | 06/14/2007 |
| NPI Last Update Date: | 01/28/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | K4497 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |