Provider Demographics
NPI:1598717977
Name:JOHNSON, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
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 1:8101 E LOWRY BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7196
Mailing Address - Country:US
Mailing Address - Phone:303-261-1600
Mailing Address - Fax:303-261-1601
Practice Address - Street 1:8101 E LOWRY BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7196
Practice Address - Country:US
Practice Address - Phone:303-261-1600
Practice Address - Fax:303-261-1601
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27793174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01277938Medicaid
E21793Medicare UPIN
CO01277938Medicaid