Basic Information
| Provider Information | |||||||||
| NPI: | 1669489340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | TEXEL | ||||||||
| MiddleName: | DEWINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1924K DAUPHIN ISLAND PKWY | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366053004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514766330 | ||||||||
| FaxNumber: | 2514731086 | ||||||||
| Practice Location | |||||||||
| Address1: | 1924K DAUPHIN ISLAND PKWY | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366053004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514766330 | ||||||||
| FaxNumber: | 2514766363 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 02/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 00010960 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 510080245 | 01 | AL | MEDICARE PTAN | OTHER |