Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 30480 | OK |
NPI | 1154617371 |
---|---|
Provider Name | Robert David Johnson |
First Address | Oklahoma City, OK 73104-5008 |
Second Address | Oklahoma City, OK 73104-5008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2011 |
Last Update Date | 12/04/2017 |