MEDICARE: DR. ANDRE LYNDON B JOHNSON DO

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	390200000X	Student in an Organized Health Care Education/Training Program	TL0008743	CO
2	207Q00000X	Family Medicine Physician	DR.73490	CO

General Provider Information

NPI Number	:	1245811280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRE LYNDON B JOHNSON DO

Provider Business Mailing Address
First Line	:	9137 RIDGELINE BLVD STE 100
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-2397
Country	:	US
Telephone Number	:	303-649-3140
Fax Number	:	303-649-3154

Provider Business Practice Location Address
First Line	:	9137 RIDGELINE BLVD STE 100
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-2397
Country	:	US
Telephone Number	:	303-649-3140
Fax Number	:	303-649-3154

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

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	02/13/2025

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