Individual
MARC A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
545 3RD ST UNIT 308, MONUMENT, CO 80132-4513
(719) 733-3086
Mailing address
PO BOX 673, MONUMENT, CO 80132-0673
(719) 650-7994
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1915
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19130538
—
CO
Enumeration date
06/15/2006
Last updated
02/03/2022
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