Healthcare Provider Details

I. General information

NPI: 1891083010
Provider Name (Legal Business Name): JEFFREY P JOHNSON, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 STAFFORD LN
DELTA CO
81416-3465
US

IV. Provider business mailing address

PO BOX 1129
DELTA CO
81416-1129
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-8026
  • Fax: 970-874-5430
Mailing address:
  • Phone: 970-874-2470
  • Fax: 970-874-2475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number50181
License Number StateCO

VIII. Authorized Official

Name: JEFFREY P JOHNSON
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 970-874-7119