Provider Demographics
NPI:1992997399
Name:JOHNSON, CHAD BARRETT (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:BARRETT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD, MBA
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Mailing Address - Street 1:6600 S YALE AVE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3347
Mailing Address - Country:US
Mailing Address - Phone:918-488-6001
Mailing Address - Fax:918-488-6010
Practice Address - Street 1:6475 S YALE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7816
Practice Address - Country:US
Practice Address - Phone:918-585-5658
Practice Address - Fax:918-585-5670
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK28719208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2341066-0664OtherDEA
ARFJ2097447OtherDEA