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Individual

STEPHEN MACKEMER JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1010 THREE SPRINGS BLVD, DURANGO, CO 81301
(303) 306-7783
(303) 306-7753
Mailing address
PO BOX 17752, DENVER, CO 80217-0752
(303) 306-7783
(303) 306-7753

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
DR0025637
CO
207R00000X
Internal Medicine Physician
DR0025637
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
64607038
CO
05
K5526
NM
Enumeration date
10/04/2006
Last updated
03/21/2014
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