Basic Information
| Provider Information | |||||||||
| NPI: | 1891083010 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEFFREY P JOHNSON, MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1129 | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814161129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708742470 | ||||||||
| FaxNumber: | 9708742475 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 STAFFORD LN | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814163465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708748026 | ||||||||
| FaxNumber: | 9708745430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2011 | ||||||||
| LastUpdateDate: | 07/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9708747119 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 50181 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.