Healthcare Provider Details

I. General information

NPI: 1487614368
Provider Name (Legal Business Name): DONALD F JOHNSON M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E BRYAN AVE
SAPULPA OK
74066-4617
US

IV. Provider business mailing address

1201 E BRYAN AVE
SAPULPA OK
74066-4617
US

V. Phone/Fax

Practice location:
  • Phone: 918-227-1000
  • Fax: 918-293-3129
Mailing address:
  • Phone: 918-227-1000
  • Fax: 918-293-3129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8456
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: