| Doctor Name: | MR. JOHNNY ROSS PAINE |
| NPI Number: | 1295708428 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O |
| License Number: | 3902 |
| Business Practice Address: | 710 A Dewitt-henry Drive Beebe, AR - 72012 |
| Business Phone Number: | 9725331767 |
| Business Fax Number: | 5012791217 |
| Mailing Address: | 710 A Dewitt-henry Drive, BEEBE |
| State: | AR |
| Postal Code: | 72012 |
| Phone Number: | 9725331767 |
| Fax Number: | 5012791217 |
| NPI Enumeration Date: | 02/08/2006 |
| NPI Last Update Date: | 05/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | 3902 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OK |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |