Individual
RYAN DOUGLAS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1840 WOODMOOR DR STE 102, MONUMENT, CO 80132-9083
(719) 622-6522
(719) 622-6520
Mailing address
2348 RAINBOWS END PT, COLORADO SPRINGS, CO 80921-7200
(719) 313-8689
(937) 465-9945
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
DR.0057733
CO
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
0057733
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
153159201
—
TX
Enumeration date
07/15/2005
Last updated
07/30/2024
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