Provider Demographics
NPI:1235279373
Name:JOHNSON, BRADLEY J (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 268922
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8922
Mailing Address - Country:US
Mailing Address - Phone:405-272-6406
Mailing Address - Fax:405-272-6075
Practice Address - Street 1:1000 N LEE AVE
Practice Address - Street 2:ROOM 4404
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1036
Practice Address - Country:US
Practice Address - Phone:405-272-6406
Practice Address - Fax:405-272-6075
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK25037207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine