Healthcare Provider Details

I. General information

NPI: 1750677894
Provider Name (Legal Business Name): MATTHEW STEPHEN JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MATT JOHNSON MD

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 09/29/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 BLAKE AVE STE 201
GLENWOOD SPRINGS CO
81601-4261
US

IV. Provider business mailing address

1830 BLAKE AVE STE 201
GLENWOOD SPRINGS CO
81601-4261
US

V. Phone/Fax

Practice location:
  • Phone: 970-384-7420
  • Fax:
Mailing address:
  • Phone: 970-384-7420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberDR.0075227
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: