Healthcare Provider Details

I. General information

NPI: 1801845631
Provider Name (Legal Business Name): STANLEY ROBIN JOHNSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 TENDERFOOT HILL ST
COLORADO SPRINGS CO
80906-3981
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-5309
  • Fax: 719-475-2042
Mailing address:
  • Phone: 719-538-2900
  • Fax: 719-538-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0000080
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: