Individual
DR. STANLEY MARK JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 E BOULDER ST, COLORADO SPRINGS, CO 80909-5533
(719) 365-5000
Mailing address
886 SPRUCE RD, LARKSPUR, CO 80118-6534
(719) 488-8868
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
04-13971
KS
207Q00000X
Family Medicine Physician
20189
MN
207Q00000X
Family Medicine Physician
Primary
39748
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20189
MEDICAL LICENSE
MN
01
—
39748
MEDICAL LICENSE
CO
01
—
O4-13971
MEDICAL LICENSE
KS
Enumeration date
01/30/2006
Last updated
03/07/2023
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