DR. Eddie Glen Johnson III, M.D.

NPI #1962738500 in Shreveport, Louisiana

Provider Information

NPI Number: 1962738500
Entity Type: Individual
Name: DR. Eddie Glen Johnson III, M.D.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: General Practice
Credential: M.D.
Enumeration Date: Nov 1, 2009
Last Updated: Nov 1, 2009

Practice Location

Address: 7330 FERN AVE STE 1103
City: Shreveport
State: Louisiana
ZIP Code: 71105-4989
Phone: (318) 798-0635

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
General Practice	208D00000X	Primary

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