Provider Demographics
NPI:1457748295
Name:JOHNSON, BRIAN DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DOUGLAS
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 1:6700 S MACARTHUR BLVD
Mailing Address - Street 2:CAMI/ AAM-320/ RM 203G
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73169-6907
Mailing Address - Country:US
Mailing Address - Phone:405-954-7652
Mailing Address - Fax:405-954-3345
Practice Address - Street 1:6700 S MACARTHUR BLVD
Practice Address - Street 2:CAMI/ AAM-320/ RM 203G
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73169-6907
Practice Address - Country:US
Practice Address - Phone:405-954-7652
Practice Address - Fax:405-954-3345
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17131207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine