Healthcare Provider Details

I. General information

NPI: 1366464794
Provider Name (Legal Business Name): STEPHEN D JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE SUITE 4400
DENVER CO
80218-1216
US

IV. Provider business mailing address

2417 DAISY LN
GOLDEN CO
80401-8081
US

V. Phone/Fax

Practice location:
  • Phone: 303-861-2266
  • Fax: 303-830-7054
Mailing address:
  • Phone: 303-526-0831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number25647
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: