MEDICARE: REGINA JOHNSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	42053	CO

General Provider Information

NPI Number	:	1144264276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA JOHNSON MD

Provider Business Mailing Address
First Line	:	4851 INDEPENDENCE ST
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-6715
Country	:	US
Telephone Number	:	303-425-0300
Fax Number	:	303-432-5790

Provider Business Practice Location Address
First Line	:	4851 INDEPENDENCE ST
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-6715
Country	:	US
Telephone Number	:	303-425-0300
Fax Number	:	303-432-5790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	02/26/2014

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