Healthcare Provider Details

I. General information

NPI: 1376525030
Provider Name (Legal Business Name): LINDA M JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W IOWA AVE
CHICKASHA OK
73018-2738
US

IV. Provider business mailing address

1370 N INTERSTATE DR SUITE 154
NORMAN OK
73072-3376
US

V. Phone/Fax

Practice location:
  • Phone: 405-224-8111
  • Fax: 405-222-9587
Mailing address:
  • Phone: 405-224-8111
  • Fax: 405-222-9587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number9060
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number9060
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: