Provider Demographics
NPI:1124103445
Name:JOHNSON, LADONNA MAE (DO)
Entity type:Individual
Prefix:DR
First Name:LADONNA
Middle Name:MAE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:201 PLAGEMAN BLDG
Mailing Address - Street 2:OREGON STATE UNIVERSITY - STUDENT HEALTH
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97331-5801
Mailing Address - Country:US
Mailing Address - Phone:541-737-3106
Mailing Address - Fax:541-737-4530
Practice Address - Street 1:201 PLAGEMAN BLDG
Practice Address - Street 2:OREGON STATE UNIVERSITY - STUDENT HEALTH
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-5801
Practice Address - Country:US
Practice Address - Phone:541-737-3106
Practice Address - Fax:541-737-4530
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORDO19146207Q00000X
CA20A5511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORE07295Medicare UPIN