| NPI | 1518316272 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY LEE JOHNSON Doctor 405-752-8819 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OK 2626) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2016-06-03 |