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General NPI Number Information
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NPI Number | 1861463648
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Entity Type | Individual
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Provider Name | STANLEY MARK JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1400 E BOULDER ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5533
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Country | US
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Telephone | 719-365-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 886 SPRUCE RD
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City | LARKSPUR
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State | CO
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Zip | 80118-6534
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Country | US
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Telephone | 719-488-8868
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 39748
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 04-13971
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20189
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License Number State | MN
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