Basic Information
| Provider Information | |||||||||
| NPI: | 1366836603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | ABBY | ||||||||
| MiddleName: | COLDREN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COLDREN | ||||||||
| OtherFirstName: | ABBY | ||||||||
| OtherMiddleName: | CAMILLE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 700 NORTH SAM HOUSTON PARKWAY WEST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328281005 | ||||||||
| FaxNumber: | 8328259461 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 BAYLOR PLZ # BCM320 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328241173 | ||||||||
| FaxNumber: | 8328259302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2015 | ||||||||
| LastUpdateDate: | 07/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | R4987 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.