Individual
DR. CLARENCE MICHAEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
802 S JACKSON AVE, SUITE 110, TULSA, OK 74127-9015
(918) 599-4477
(918) 599-4479
Mailing address
PO BOX 368, CLAREMORE, OK 74018-0368
(918) 343-6100
(918) 341-6363
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
1716
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100088070A
—
OK
Enumeration date
07/19/2006
Last updated
07/13/2012
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