Healthcare Provider Details

I. General information

NPI: 1033138565
Provider Name (Legal Business Name): KRIS ALAN JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 VAN GORDON ST SUITE #395
LAKEWOOD CO
80228-1709
US

IV. Provider business mailing address

155 VAN GORDON ST SUITE #395
LAKEWOOD CO
80228-1709
US

V. Phone/Fax

Practice location:
  • Phone: 303-914-2680
  • Fax:
Mailing address:
  • Phone: 303-914-2680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number039337
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number39337
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: