Healthcare Provider Details

I. General information

NPI: 1497910970
Provider Name (Legal Business Name): VICTORIA LYNN JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6442 AVONDALE DR
NICHOLS HILLS OK
73116-6404
US

IV. Provider business mailing address

6442 AVONDALE DR
NICHOLS HILLS OK
73116-6404
US

V. Phone/Fax

Practice location:
  • Phone: 405-841-0500
  • Fax: 405-841-0504
Mailing address:
  • Phone: 405-841-0500
  • Fax: 405-841-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number20232
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: