Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 38408 | CO |
Y | 208600000X | Surgeon | 38408 | CO |
NPI | 1013921188 |
---|---|
Provider Name | Jeffrey L Johnson |
First Address | Denver, CO 80204-4507 |
Second Address | Denver, CO 80204-4507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
67982778 | (05) | CO |
H11053 | (02) | |
P00083365 | RAILROAD MEDICARE (01) | CO |