Individual
BRADLEY TODD JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1010 THREE SPRINGS BLVD, DURANGO, CO 81301-8296
(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
363A00000X
Physician Assistant
Primary
3202
CO
363A00000X
Physician Assistant
956
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35323884
—
NM
05
—
48483885
—
CO
Enumeration date
11/08/2007
Last updated
11/03/2020
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