=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619314200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONALD JOHN MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2013
-----------------------------------------------------
Last Update Date | 07/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4206 CALL FIELD RD
-----------------------------------------------------
City | WICHITA FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76308-2519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-397-5200
-----------------------------------------------------
Fax | 940-397-5292
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4206 CALL FIELD RD
-----------------------------------------------------
City | WICHITA FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76308-2519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-397-5200
-----------------------------------------------------
Fax | 940-397-5292
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DONALD H JOHN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 940-397-5200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | E4431
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------