Individual
MRS. BRETONYA JANEY PHILLIPS-JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5501 N PORTLAND AVE, OKLAHOMA CITY, OK 73112-2074
(405) 604-6000
Mailing address
12317 WILLIAMSPORT AVENUE, OKLAHOMA CITY, OK 73120
(405) 625-1778
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
125058881
IL
207L00000X
Anesthesiology Physician
Primary
30415
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125058881
MEDICAL LICENSE
IL
01
—
30415
MEDICAL LICENSE
OK
Enumeration date
08/22/2010
Last updated
05/04/2016
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