Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036119004 | IL |
N | 111NI0900X | Internist | 036119004 | IL |
N | 207R00000X | Internist | A95435 | CA |
N | 111NI0900X | Internist | A95435 | CA |
Y | 207RA0401X | Internist - Addiction Medicine | 0058849 | CO |
NPI | 1538239520 |
---|---|
Provider Name | Dr. Chad R. Johnston |
First Address | Denver, CO 80218-2391 |
Second Address | Denver, CO 80218-2391 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 07/11/2018 |