Provider Demographics
NPI:1245811280
Name:JOHNSON, ANDRE LYNDON B (DO)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:LYNDON B
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9137 RIDGELINE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2397
Mailing Address - Country:US
Mailing Address - Phone:303-649-3140
Mailing Address - Fax:303-649-3154
Practice Address - Street 1:9137 RIDGELINE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2397
Practice Address - Country:US
Practice Address - Phone:303-649-3140
Practice Address - Fax:303-649-3154
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL0008743390200000X
CODR.73490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program