Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | 01062005A | IN |
Y | 2080P0203X | Pediatric Critical Care Doctor | 38356 | CO |
NPI | 1023077740 |
---|---|
Provider Name | Dr. Christopher Miles Johnson |
First Address | Manitou Springs, CO 80829-1613 |
Second Address | Manitou Springs, CO 80829-1613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 07/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200825210 | (05) | IN |
D83750 | (02) | CO |