| Frederick C Johnson, DO | |
|
12221 Merit Dr, Suite 1610, Dallas, TX 75251-2202 | |
| (214) 217-1911 | |
| Not Available |
| Full Name | Frederick C Johnson |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 12221 Merit Dr, Dallas, Texas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205851672 | NPI | - | NPPES |
| 8S2689 | Other | TX | BCBS |
| 164307406 | Medicaid | TX | |
| 23981741 | Medicaid | NM | |
| 164307403 | Medicaid | TX | |
| 164307404 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | L4474 (Texas) | Primary |
| 2080P0204X | Pediatrics - Pediatric Emergency Medicine | L4474 (Texas) | Secondary |
| Entity Name | Pediatric Emergency Medicine Group, Llp |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1629448535 PECOS PAC ID: 9931409943 Enrollment ID: O20151124000478 |
| Mailing Address | Practice Location Address |
|---|---|
| Frederick C Johnson, DO 7914 Enclave Way, Dallas, TX 75218-4502 Ph: (214) 263-1445 | Frederick C Johnson, DO 12221 Merit Dr, Suite 1610, Dallas, TX 75251-2202 Ph: (214) 217-1911 |
Dr. Jyothsna Gattineni, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 5323 Harry Hines Blvd, Dallas, TX 75390 Phone: 214-648-3438 | |
Ruth Osei Fordjour, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 12221 Merit Dr, Suite 1500, Dallas, TX 75251 Phone: 214-957-4754 | |
Dr. Alecia Curlene Nero, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 5323 Harry Hines Blvd, Dallas, TX 75390 Phone: 214-648-4180 | |
Dr. Sravani Avula, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 5323 Harry Hines Blvd, Dallas, TX 75390 Phone: 214-730-5437 | |
Asif Zia Khattak, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 3500 Gaston Ave, Dallas, TX 75246 Phone: 214-820-7604 | |
Sadia Malik, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 5323 Harry Hines Boulevard, Dallas, TX 75390 Phone: 214-456-2533 Fax: 214-456-8130 | |
Amanda June Clark, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 1935 Medical District Dr, Dallas, TX 75235 Phone: 615-943-4809 |