Provider Demographics
NPI:1871753939
Name:JOHNSON, MICHAEL BRANDON (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRANDON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 BROADWAY EXTENSION
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114
Mailing Address - Country:US
Mailing Address - Phone:405-424-5417
Mailing Address - Fax:405-424-5418
Practice Address - Street 1:9800 BROADWAY EXTENSION
Practice Address - Street 2:SUITE 203
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114
Practice Address - Country:US
Practice Address - Phone:405-424-5417
Practice Address - Fax:405-424-5418
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26521207X00000X
CAA126329207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery