Individual
DR. CHARLES LARUE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
155 PRINTERS PKWY, SUITE 230, COLORADO SPRINGS, CO 80910-6100
(719) 635-5657
(719) 578-9014
Mailing address
155 PRINTERS PKWY, SUITE 230, COLORADO SPRINGS, CO 80910-6100
(719) 635-5657
(719) 578-9014
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18812
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01088129
—
CO
Enumeration date
04/20/2006
Last updated
03/01/2010
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