Provider Demographics
NPI:1477546042
Name:JOHNSON, RICHARD ERIC (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ERIC
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502-0785
Mailing Address - Country:US
Mailing Address - Phone:580-355-8620
Mailing Address - Fax:580-357-3277
Practice Address - Street 1:3401 W GORE BLVD
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73502-0129
Practice Address - Country:US
Practice Address - Phone:580-355-8620
Practice Address - Fax:580-536-2292
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20908207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100003940AMedicaid
F37273Medicare UPIN