=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033565908
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY JEANNE JOHNSON MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2016
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2101 E 48TH AVE
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80216-2253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-458-5302
-----------------------------------------------------
Fax | 303-583-0152
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4725 HIGH ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80216-2220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-458-5302
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 35.146915
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | DR.0062604
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------