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General NPI Number Information
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NPI Number | 1235792375
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Entity Type | Individual
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Provider Name | BENJAMIN TANKEVER JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 2600 E 18TH ST
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City | CHEYENNE
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State | WY
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Zip | 82001-5511
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Country | US
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Telephone | 307-633-7370
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Fax | 307-637-7202
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Provider Business Mailing Address
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Address Line | 13001 E 17TH PL BLDG 500
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City | AURORA
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State | CO
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Zip | 80045-2570
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Country | US
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Telephone | 303-724-6019
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 16324A
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License Number State | WY
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