MEDICARE: RYAN DOUGLAS JOHNSON M.D.

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	207Q00000X	Family Medicine Physician	DR.0057733	CO
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	0057733	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184623878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN DOUGLAS JOHNSON M.D.

Provider Business Mailing Address
First Line	:	2348 RAINBOWS END PT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-7200
Country	:	US
Telephone Number	:	719-313-8689
Fax Number	:	937-465-9945

Provider Business Practice Location Address
First Line	:	1840 WOODMOOR DR STE 102
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-9083
Country	:	US
Telephone Number	:	719-622-6522
Fax Number	:	719-622-6520

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/30/2024

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