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NPI Code Detail

MEDICARE: DR. ROGER MILBORN JOHNSON M.D.

MEDICARE:  DR. ROGER MILBORN 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
12084P0800XPsychiatry Physician18515CO

General Provider Information

NPI Number : 1699738427
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROGER MILBORN JOHNSON M.D.
Provider Business Mailing Address
First Line : 2360 EAST PERSHING BLVD.
Second Line :
City : CHEYENNE
State : WY
Zip : 82001
Country : US
Telephone Number : 307-778-7307
Fax Number : 307-778-7381
Provider Business Practice Location Address
First Line : 2360 E PERSHING BLVD
Second Line :
City : CHEYENNE
State : WY
Zip : 82001-5356
Country : US
Telephone Number : 307-778-7307
Fax Number : 307-778-7381
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2006
Last Update Date : 07/08/2007

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Directions to “ DR. ROGER MILBORN JOHNSON M.D.” Practice Location

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