Provider Demographics
NPI:1801236948
Name:WARREN T. JOHNSON
Entity type:Organization
Organization Name:WARREN T. JOHNSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-655-1111
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01248277Medicaid