Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 14767 | OK |
NPI | 1497971733 |
---|---|
Provider Name | Dr. Paul Davis Johnson |
First Address | Oklahoma City, OK 73149-2740 |
Second Address | Oklahoma City, OK 73149-2740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 08/12/2011 |