Provider Demographics
NPI:1033100839
Name:JOHNSTON, CRAIG RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:RAYMOND
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 N ARLINGTON AVE
Mailing Address - Street 2:101
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3286
Mailing Address - Country:US
Mailing Address - Phone:317-352-9171
Mailing Address - Fax:317-353-0287
Practice Address - Street 1:1311 N ARLINGTON AVE
Practice Address - Street 2:101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3286
Practice Address - Country:US
Practice Address - Phone:317-352-9171
Practice Address - Fax:317-353-0287
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026881A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN115340AMedicare ID - Type Unspecified