Healthcare Provider Details

I. General information

NPI: 1205017530
Provider Name (Legal Business Name): DONNA A. JOHNSON, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 S WALKER AVE STE 200
OKLAHOMA CITY OK
73139-9402
US

IV. Provider business mailing address

8100 S WALKER AVE STE 200
OKLAHOMA CITY OK
73139-9402
US

V. Phone/Fax

Practice location:
  • Phone: 405-629-5343
  • Fax:
Mailing address:
  • Phone: 405-629-5343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18635
License Number StateOK

VIII. Authorized Official

Name: DONNA A JOHNSON
Title or Position: PHYSICIAN
Credential:
Phone: 405-629-5343