Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CO15753 | CO |
NPI | 1326034620 |
---|---|
Provider Name | Mr. Joseph L Johnson |
First Address | Windsor, CO 80550-3148 |
Second Address | Windsor, CO 80550-3148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 10/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117954300 | (05) | WY |
97021032 | (05) | CO |