MEDICARE: MICHAEL D JOHN MD PC

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	207N00000X	Dermatology Physician	15126	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2532523004	OTHER	OK	CIGNA
2	4234977	OTHER	OK	AETNA
3	402760407001	OTHER	OK	BLUE CROSS BLUE SHIEL

General Provider Information

NPI Number	:	1912043019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL D JOHN MD PC

Provider Business Mailing Address
First Line	:	620 W 15TH ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-3617
Country	:	US
Telephone Number	:	405-359-0551
Fax Number	:	405-359-3061

Provider Business Practice Location Address
First Line	:	620 W 15TH ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-3617
Country	:	US
Telephone Number	:	405-359-0551
Fax Number	:	405-359-3061

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL D JOHN
Credential	:	MD
Telephone Number	:	405-359-0551

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/22/2020

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