Individual
MIRANDA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
635 W 11TH ST, TULSA, OK 74127-9014
(918) 561-5701
Mailing address
2345 SOUTHWEST BLVD, TULSA, OK 74107-2705
(918) 561-5701
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4528
OK
Other
Enumeration date
02/05/2008
Last updated
02/05/2008
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