Provider Demographics
NPI:1043377740
Name:JOHNSON, JANIS LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANIS
Middle Name:LOUISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E 19TH AVE STE 5300
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1229
Mailing Address - Country:US
Mailing Address - Phone:303-839-7440
Mailing Address - Fax:303-839-7210
Practice Address - Street 1:1601 E 19TH AVE STE 5300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1229
Practice Address - Country:US
Practice Address - Phone:303-839-7440
Practice Address - Fax:303-839-7210
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO306592080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1306596Medicaid
CO1306596Medicaid