Healthcare Provider Details

I. General information

NPI: 1326099227
Provider Name (Legal Business Name): THEODORE STANLEY JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT. # 1029
DENVER CO
80263-0001
US

IV. Provider business mailing address

DEPT # 1029
DENVER CO
80263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 352-867-8898
  • Fax: 352-732-6282
Mailing address:
  • Phone: 352-867-8898
  • Fax: 352-732-6282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME30185
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: