Healthcare Provider Details

I. General information

NPI: 1497971733
Provider Name (Legal Business Name): PAUL DAVIS JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 S I 35 SERVICE RD SUITE # 7
OKLAHOMA CITY OK
73149-2740
US

IV. Provider business mailing address

7100 S I 35 SERVICE RD SUITE # 7
OKLAHOMA CITY OK
73149-2740
US

V. Phone/Fax

Practice location:
  • Phone: 405-632-1002
  • Fax: 405-632-3131
Mailing address:
  • Phone: 405-632-1002
  • Fax: 405-632-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number14767
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: