Provider Demographics
NPI:1457381279
Name:JOHNSON, WARREN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:THOMAS
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 1:70 S 20TH AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-3703
Mailing Address - Country:US
Mailing Address - Phone:303-655-1111
Mailing Address - Fax:303-655-1172
Practice Address - Street 1:70 S 20TH AVE
Practice Address - Street 2:SUITE H
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-3703
Practice Address - Country:US
Practice Address - Phone:303-655-1111
Practice Address - Fax:303-655-1172
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01248277Medicaid
D24523Medicare UPIN