# MR. JOHNNY ROSS PAINE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1295708428
- **Gender:** Man
- **Credential:** D.O

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | L4621 | TX | — |
| 207QA0505X | Adult Medicine Physician | 3902 | OK | — |
| 207QA0505X | Adult Medicine Physician | R-3454 | AR | Yes |

## Other

- **Enumeration date:** 02/08/2006
- **Last updated:** 02/16/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 103756003 | — | AR |
| 05 | — | 1203902 | — | OK |
| 05 | — | 197838901 | — | TX |
| 05 | — | 197838902 | — | TX |