Individual
AUSTIN L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1111 W 17TH ST, TULSA, OK 74107-1886
(208) 569-0031
Mailing address
4017 S 149TH EAST AVE, TULSA, OK 74134-4861
(208) 569-0031
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/01/2021
Last updated
07/01/2021
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