Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 27850 | OK |
NPI | 1043531114 |
---|---|
Provider Name | Adam Johnson |
First Address | Oklahoma City, OK 73104-5033 |
Second Address | Oklahoma City, OK 73104-5033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2010 |
Last Update Date | 14/06/2010 |