Provider Demographics
NPI:1033317730
Name:JOHNSTON FLANDERS, MEGAN SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:SUSAN
Last Name:JOHNSTON FLANDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:SUSAN
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32021 COUNTY 24 BLVD
Mailing Address - Street 2:
Mailing Address - City:CANNON FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55009-5003
Mailing Address - Country:US
Mailing Address - Phone:507-263-6000
Mailing Address - Fax:
Practice Address - Street 1:32021 COUNTY 24 BLVD
Practice Address - Street 2:
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009-5003
Practice Address - Country:US
Practice Address - Phone:507-263-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11013785A208D00000X
MN54701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1033317730Medicaid