Doctor Name: | DEVEN ANTHONY JOHNSON |
NPI Number: | 1962812164 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 28834 |
Business Practice Address: | 2200 Bergquist Dr Ste 1 Lackland Afb, TX - 782369908 |
Business Phone Number: | 2109168687 |
Business Fax Number: | 2102925944 |
Mailing Address: | 2200 Bergquist Dr Ste 1, LACKLAND AFB |
State: | TX |
Postal Code: | 782369908 |
Phone Number: | 2109168687 |
Fax Number: | 2102925944 |
NPI Enumeration Date: | 04/28/2014 |
NPI Last Update Date: | 11/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 28834 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NE |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |