Jack Johnson

NPI #1154075554 in Bastrop, Texas

Provider Information

NPI Number: 1154075554
Entity Type: Individual
Name: Jack Johnson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physician Assistant
Enumeration Date: Feb 5, 2022
Last Updated: Feb 5, 2022

Practice Location

Address: 212 CREEK LOOP RD
City: Bastrop
State: Texas
ZIP Code: 78602-3197
Phone: (512) 988-6564

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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