Provider Demographics
NPI:1750324232
Name:JOHNSON, PAUL E (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:E
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 1:12687 W CEDAR DR
Mailing Address - Street 2:200
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2014
Mailing Address - Country:US
Mailing Address - Phone:303-468-1395
Mailing Address - Fax:303-468-1394
Practice Address - Street 1:1397 WEIMER RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6253
Practice Address - Country:US
Practice Address - Phone:575-758-8883
Practice Address - Fax:303-468-1394
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20020304174400000X
NMMD2002-03042085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM82923884Medicaid
NMI03894Medicare UPIN
NMNM301877Medicare UPIN
NM345515702Medicare ID - Type Unspecified
NM82923884Medicaid