Healthcare Provider Details

I. General information

NPI: 1679554836
Provider Name (Legal Business Name): TAMRA L JOHNSTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 S ABILENE ST STE 250
AURORA CO
80014-2353
US

IV. Provider business mailing address

7753 S JERSEY WAY
CENTENNIAL CO
80112-2452
US

V. Phone/Fax

Practice location:
  • Phone: 303-369-1785
  • Fax:
Mailing address:
  • Phone: 303-217-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36902
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number46948
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: