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General NPI Number Information
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NPI Number | 1326230939
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Entity Type | Organization
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Legal Business Name | TAOS MOUNTAIN RADIOLOGY INC
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 1397 WEIMER RD RADIOLOGY DEPARTMENT
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City | TAOS
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State | NM
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Zip | 87571-6284
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Country | US
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Telephone | 505-758-8883
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Fax | 505-751-7661
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Provider Business Mailing Address
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Address Line | 12687 W CEDAR DR SUITE 300
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City | LAKEWOOD
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State | CO
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Zip | 80228-2010
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Country | US
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Telephone | 303-468-1395
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Fax | 303-468-1394
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | DR. PAUL EATON JOHNSON
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Credential | M.D.
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Telephone | 505-758-8883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD2002-0304
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License Number State | NM
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