Provider Demographics
NPI:1326811381
Name:JOHNSON, JAY HOMER SR
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:HOMER
Last Name:JOHNSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 E 31ST ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5010
Mailing Address - Country:US
Mailing Address - Phone:918-350-5535
Mailing Address - Fax:
Practice Address - Street 1:5330 E 31ST ST STE 1000
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5010
Practice Address - Country:US
Practice Address - Phone:918-350-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist