Individual
MR. JOHNNY ROSS PAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
15 SILVER OAK DR, SEARCY, AR 72143-4584
(972) 533-1767
(501) 279-1217
Mailing address
PO BOX 639, THIENSVILLE, WI 53092-0639
(414) 247-9005
(414) 247-9004
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
L4621
TX
207QA0505X
Adult Medicine Physician
3902
OK
207QA0505X
Adult Medicine Physician
Primary
R-3454
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103756003
—
AR
05
—
1203902
—
OK
05
—
197838901
—
TX
05
—
197838902
—
TX
Enumeration date
02/08/2006
Last updated
02/16/2024
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