Provider Demographics
NPI:1275530263
Name:JOHANNES, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:JOHANNES
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 1:96 WADSWORTH BLVD UNIT 100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-1516
Mailing Address - Country:US
Mailing Address - Phone:303-239-8327
Mailing Address - Fax:303-239-9946
Practice Address - Street 1:96 WADSWORTH BLVD UNIT 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1516
Practice Address - Country:US
Practice Address - Phone:303-239-8327
Practice Address - Fax:303-239-9946
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33741208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01337427Medicaid
CO01337427Medicaid