Healthcare Provider Details

I. General information

NPI: 1437226404
Provider Name (Legal Business Name): JOY LEDOUX JOHNSON MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10908 N WESTERN AVE
OKLAHOMA CITY OK
73114-7068
US

IV. Provider business mailing address

4401 W MEMORIAL RD SUITE #141, ATTENTION BECKY
OKLAHOMA CITY OK
73134-1785
US

V. Phone/Fax

Practice location:
  • Phone: 405-608-0323
  • Fax: 405-608-0328
Mailing address:
  • Phone: 405-936-5811
  • Fax: 405-936-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JOY LEDOUX JOHNSON
Title or Position: OWNER
Credential: MD
Phone: 405-608-0323