Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MT211505 | PA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | DR.0066172 | CO |
NPI | 1154771327 |
---|---|
Provider Name | Alexander Joseph Johnson |
First Address | Aurora, CO 80042-0429 |
Second Address | Boulder, CO 80309-5103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2016 |
Last Update Date | 23/07/2021 |