Individual
RUSSELL ADAM JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3211 W 20TH ST STE D, GREELEY, CO 80634-6566
(970) 356-3100
(970) 356-4827
Mailing address
3211 W 20TH ST STE D, GREELEY, CO 80634-6566
(970) 356-3100
(970) 356-4827
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
32618
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01326180
—
CO
01
—
065216
VALUE OPTIONS
CO
01
—
643345
BLUE CROSS
CO
Enumeration date
07/25/2006
Last updated
07/09/2007
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