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General NPI Number Information
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NPI Number | 1417091273
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Entity Type | Organization
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Legal Business Name | WAYNE A JOHNSON MD PC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 09/26/2008
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Provider Practice Location Address
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Address Line | 904 SW 38TH ST
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City | LAWTON
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State | OK
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Zip | 73505-7021
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Country | US
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Telephone | 580-353-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 904 SW 38TH ST
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City | LAWTON
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State | OK
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Zip | 73505-7021
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Country | US
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Telephone | 580-353-8600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WAYNE ANTHONY JOHNSON
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Credential | M.D.
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Telephone | 580-353-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 19138
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License Number State | OK
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