Provider Demographics
NPI:1497910970
Name:JOHNSON, VICTORIA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6442 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLS HILLS
Mailing Address - State:OK
Mailing Address - Zip Code:73116-6404
Mailing Address - Country:US
Mailing Address - Phone:405-841-0500
Mailing Address - Fax:405-841-0504
Practice Address - Street 1:6442 AVONDALE DR
Practice Address - Street 2:
Practice Address - City:NICHOLS HILLS
Practice Address - State:OK
Practice Address - Zip Code:73116-6404
Practice Address - Country:US
Practice Address - Phone:405-841-0500
Practice Address - Fax:405-841-0504
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK20232208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery