Organization
J KEVIN JOHNSON MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
J KEVIN JOHNSON MD (DOCTOR)
(719) 542-3100
Entity
Organization
Contact information
Practice address
1600 NORTH GRAND, SUITE 520, PUEBLO, CO 81003
(719) 542-3100
(719) 542-3100
Mailing address
1600 NORTH GRAND, SUITE 520, PUEBLO, CO 81003
(719) 542-3100
(719) 542-3110
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01365246
—
CO
01
—
DD7190
RAILROAD MEDICARE
CO
Enumeration date
08/21/2006
Last updated
06/18/2008
Update your record
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