MEDICARE: DR. VICTORIA LYNN JOHNSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	20232	OK

General Provider Information

NPI Number	:	1497910970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTORIA LYNN JOHNSON MD

Provider Business Mailing Address
First Line	:	6442 AVONDALE DR
Second Line	:
City	:	NICHOLS HILLS
State	:	OK
Zip	:	73116-6404
Country	:	US
Telephone Number	:	405-841-0500
Fax Number	:	405-841-0504

Provider Business Practice Location Address
First Line	:	6442 AVONDALE DR
Second Line	:
City	:	NICHOLS HILLS
State	:	OK
Zip	:	73116-6404
Country	:	US
Telephone Number	:	405-841-0500
Fax Number	:	405-841-0504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2008
Last Update Date	:	07/23/2008

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