Provider Demographics
NPI:1033138565
Name:JOHNSON, KRIS ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRIS
Middle Name:ALAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 VAN GORDON ST
Mailing Address - Street 2:SUITE #395
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1709
Mailing Address - Country:US
Mailing Address - Phone:303-914-2680
Mailing Address - Fax:
Practice Address - Street 1:155 VAN GORDON ST
Practice Address - Street 2:SUITE #395
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1709
Practice Address - Country:US
Practice Address - Phone:303-914-2680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO039337207QA0505X
CO39337208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95052321Medicaid
COH28995Medicare UPIN
CO95052321Medicaid