Individual
MARK BROCKBANK JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1120 S UTICA AVE, TULSA, OK 74104-4012
(918) 579-1000
Mailing address
PO BOX 9188, LONGVIEW, TX 75608-9188
(903) 663-3600
(903) 663-3629
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
90512
OK
Other
Enumeration date
10/22/2007
Last updated
10/22/2007
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