MEDICARE: DR. KRIS ALAN JOHNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	039337	CO
2	208M00000X	Hospitalist Physician	39337	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033138565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRIS ALAN JOHNSON M.D.

Provider Business Mailing Address
First Line	:	155 VAN GORDON ST
Second Line	:	SUITE #395
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-1709
Country	:	US
Telephone Number	:	303-914-2680
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 VAN GORDON ST
Second Line	:	SUITE #395
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-1709
Country	:	US
Telephone Number	:	303-914-2680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	12/21/2007

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