Provider Demographics
NPI:1295946283
Name:JOHNSON, DEREK RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:RYAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9949 S OSWEGO ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3753
Mailing Address - Country:US
Mailing Address - Phone:303-925-4750
Mailing Address - Fax:303-925-4751
Practice Address - Street 1:9949 S OSWEGO ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3753
Practice Address - Country:US
Practice Address - Phone:303-925-4750
Practice Address - Fax:303-925-4751
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2017-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301081956207X00000X
CO46601207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery