Provider Demographics
NPI:1427185446
Name:JOHNSON, MARIE F (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:F
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 1:2550 S PARKER RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1622
Mailing Address - Country:US
Mailing Address - Phone:303-636-3350
Mailing Address - Fax:303-636-3358
Practice Address - Street 1:2550 S PARKER RD STE 400
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1677
Practice Address - Country:US
Practice Address - Phone:303-636-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35160207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
015584OtherKAISER-COMMERCIAL NUMBER
CO15833887Medicaid
COF96148Medicare UPIN
COC547238Medicare PIN