Healthcare Provider Details

I. General information

NPI: 1851682470
Provider Name (Legal Business Name): JORDAN S JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2011
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9821 S MAY AVE STE C
OKLAHOMA CITY OK
73159-7042
US

IV. Provider business mailing address

3037 NW 63RD ST STE W251
OKLAHOMA CITY OK
73116-3637
US

V. Phone/Fax

Practice location:
  • Phone: 405-691-0505
  • Fax: 405-691-0507
Mailing address:
  • Phone: 405-691-0505
  • Fax: 405-691-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number32660
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: