1326099227 NPI number — THEODORE STANLEY JOHNSON MD

Table of content: MIREYA GAMBOA (NPI 1144919804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326099227 NPI number — THEODORE STANLEY JOHNSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
THEODORE
Provider Middle Name:
STANLEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326099227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT # 1029
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80263-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-867-8898
Provider Business Mailing Address Fax Number:
352-732-6282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DEPT. # 1029
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80263-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-867-8898
Provider Business Practice Location Address Fax Number:
352-732-6282
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  ME30185 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01301852 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: D4548 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: A6528 . This is a "ANTHEM/BLUE CROSS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com