Provider Demographics
NPI:1891094074
Name:JOHNSON, JOSEPH DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DOUGLAS
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 1:8175 SHERIDAN BLVD
Mailing Address - Street 2:UNIT N
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-1956
Mailing Address - Country:US
Mailing Address - Phone:303-557-0855
Mailing Address - Fax:720-336-3149
Practice Address - Street 1:8405 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2908
Practice Address - Country:US
Practice Address - Phone:720-974-5400
Practice Address - Fax:720-974-4992
Is Sole Proprietor?:No
Enumeration Date:2011-03-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR-53960207R00000X
CODR.0053960207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicaid