Provider Demographics
NPI:1154499234
Name:JOHNSON, CLIFFORD DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:DEAN
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 1:10485 N. SHERIDAN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020
Mailing Address - Country:US
Mailing Address - Phone:303-466-8344
Mailing Address - Fax:833-795-1962
Practice Address - Street 1:10485 N. SHERIDAN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020
Practice Address - Country:US
Practice Address - Phone:303-466-8344
Practice Address - Fax:833-795-1962
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0421454207Q00000X
CODR0053168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100135680BMedicaid
KS100135680BMedicaid
C487220Medicare ID - Type Unspecified