Healthcare Provider Details

I. General information

NPI: 1477546042
Provider Name (Legal Business Name): RICHARD ERIC JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 W GORE BLVD DEPARTMENT OF ANESTHESIOLOGY
LAWTON OK
73502-0129
US

IV. Provider business mailing address

PO BOX 785
LAWTON OK
73502-0785
US

V. Phone/Fax

Practice location:
  • Phone: 580-355-8620
  • Fax: 580-536-2292
Mailing address:
  • Phone: 580-355-8620
  • Fax: 580-357-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20908
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: