Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4301081956 | MI |
N | 207X00000X | Orthopaedic Surgeon | 46601 | CO |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 46601 | CO |
NPI | 1295946283 |
---|---|
Provider Name | Dr. Derek Ryan Johnson |
First Address | Parker, CO 80134-3753 |
Second Address | Parker, CO 80134-3753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 13/04/2017 |