Provider Demographics
NPI:1124466016
Name:JOHANSON, ANNA (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:JOHANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1213
Mailing Address - Street 2:
Mailing Address - City:TABERNASH
Mailing Address - State:CO
Mailing Address - Zip Code:80478-0207
Mailing Address - Country:US
Mailing Address - Phone:720-284-2814
Mailing Address - Fax:
Practice Address - Street 1:78878 US HIGHWAY 40 WINTER PARK, CO 80482
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:CO
Practice Address - Zip Code:80482
Practice Address - Country:US
Practice Address - Phone:970-812-8765
Practice Address - Fax:970-788-7518
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine