Healthcare Provider Details

I. General information

NPI: 1982945788
Provider Name (Legal Business Name): WAYNE WILLIAM JOHNSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 01/13/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 E HAMPDEN AVE #400
ENGLEWOOD CO
80113-2700
US

IV. Provider business mailing address

4900 S MONACO ST #210
DENVER CO
80237-3486
US

V. Phone/Fax

Practice location:
  • Phone: 303-789-2663
  • Fax: 303-788-4871
Mailing address:
  • Phone: 303-789-2663
  • Fax: 303-788-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number243
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: