Provider Demographics
NPI:1104851815
Name:JOHNSON, DARLENE G (MD)
Entity Type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:G
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DARLENE
Other - Middle Name:GUINETTE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9220 S PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6937
Mailing Address - Country:US
Mailing Address - Phone:405-692-1331
Mailing Address - Fax:405-692-0082
Practice Address - Street 1:9220 S PENNSYLVANIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6937
Practice Address - Country:US
Practice Address - Phone:405-692-1331
Practice Address - Fax:405-692-0082
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16599208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731382009OtherBCBS
OKD39239Medicare UPIN
OK$$$$$$$$$Medicare PIN