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NPI Code Detail

MEDICARE: TERESA MARIA JOHNSON MD

MEDICARE: TERESA MARIA 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
1207R00000XInternal Medicine PhysicianDR.0063952CO

General Provider Information

NPI Number : 1255863510
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA MARIA JOHNSON MD
Provider Business Mailing Address
First Line : 1906 BLAKE AVE
Second Line :
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-4259
Country : US
Telephone Number : 970-384-7033
Fax Number : 970-384-8174
Provider Business Practice Location Address
First Line : 1906 BLAKE AVE
Second Line :
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-4259
Country : US
Telephone Number : 970-384-7340
Fax Number : 970-928-2530
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2017
Last Update Date : 09/23/2020

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