Individual
MARK DANIEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
13401 N WESTERN AVE STE 301, OKLAHOMA CITY, OK 73114-1411
(405) 360-6764
(405) 360-6769
Mailing address
3400 W TECUMSEH RD, STE 101, NORMAN, OK 73072-1810
(405) 360-6764
(405) 360-6769
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
485
OK
Other
Enumeration date
10/20/2005
Last updated
11/26/2018
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