Organization
MICHAEL D JOHN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL D JOHN MD (PRESIDENT)
(405) 359-0551
Entity
Organization
Contact information
Practice address
620 W 15TH ST, EDMOND, OK 73013-3617
(405) 359-0551
(405) 359-3061
Mailing address
620 W 15TH ST, EDMOND, OK 73013-3617
(405) 359-0551
(405) 359-3061
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
15126
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2532523004
CIGNA
OK
01
—
402760407001
BLUE CROSS BLUE SHIEL
OK
01
—
4234977
AETNA
OK
Enumeration date
01/29/2007
Last updated
08/22/2020
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