Provider Demographics
NPI:1801860101
Name:JOHNSON, HAROLD L (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3586
Mailing Address - Country:US
Mailing Address - Phone:303-440-3000
Mailing Address - Fax:
Practice Address - Street 1:2750 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3586
Practice Address - Country:US
Practice Address - Phone:303-440-3102
Practice Address - Fax:303-440-3175
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0034800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G15370Medicare UPIN
FL44305VMedicare PIN