Provider Demographics
NPI:1679626204
Name:JOHNNY E JOHNSON JR M D P C
Entity type:Organization
Organization Name:JOHNNY E JOHNSON JR M D P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:303-261-3825
Mailing Address - Street 1:4545 E 9TH AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3901
Mailing Address - Country:US
Mailing Address - Phone:303-261-3825
Mailing Address - Fax:303-261-3827
Practice Address - Street 1:4545 E 9TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3901
Practice Address - Country:US
Practice Address - Phone:303-261-3825
Practice Address - Fax:303-261-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22809207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty