MEDICARE: KURT S. JOHNSON, MD, PC

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	6832A	WY

General Provider Information

NPI Number	:	1215941638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KURT S. JOHNSON, MD, PC

Provider Business Mailing Address
First Line	:	3236 E GRAND AVE STE G
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-5100
Country	:	US
Telephone Number	:	307-742-3242
Fax Number	:	307-742-3282

Provider Business Practice Location Address
First Line	:	3236 E GRAND AVE STE G
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-5100
Country	:	US
Telephone Number	:	307-742-3242
Fax Number	:	307-742-3282

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KURT S. JOHNSON
Credential	:	MD
Telephone Number	:	307-742-3242

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/22/2020

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