Provider Demographics
NPI:1609927342
Name:JOHNSON, SHAWN EVETTE (MD)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:EVETTE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23390 PLANTATION LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:TX
Mailing Address - Zip Code:77445-8013
Mailing Address - Country:US
Mailing Address - Phone:936-463-1913
Mailing Address - Fax:936-873-8647
Practice Address - Street 1:3720 WESTHEIMER RD STE 601
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5277
Practice Address - Country:US
Practice Address - Phone:936-463-1913
Practice Address - Fax:936-873-8647
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3902207XX0005X, 207X00000X
NE23310207X00000X
VA0101252896207X00000X
LAMD.205784207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05024837Medicaid
VA1609927342Medicaid
TX3925117Medicaid
LA2334361Medicaid
LA369912YH3UMedicare PIN