Individual
CARL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 S 12TH ST, MCALESTER, OK 74501-5656
(918) 470-7869
Mailing address
101 S 12TH ST, MCALESTER, OK 74501-5656
(918) 470-7869
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
10/03/2011
Last updated
10/03/2011
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