Provider Demographics
NPI:1104865732
Name:JOHNSON, JESSICA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4600 HALE PKWY
Mailing Address - Street 2:WOLF BUILDING, STE. 400
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4020
Mailing Address - Country:US
Mailing Address - Phone:303-321-2166
Mailing Address - Fax:303-861-7211
Practice Address - Street 1:4600 HALE PKWY
Practice Address - Street 2:WOLF BUILDING, STE. 400
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4020
Practice Address - Country:US
Practice Address - Phone:303-321-2166
Practice Address - Fax:303-861-7211
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31913207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO160033547OtherRAILROAD MEDICARE
COC61754Medicare PIN
COF59820Medicare UPIN