Provider Demographics
NPI:1033324140
Name:JOHNSTON, JEFFREY LEBOURGEOIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEBOURGEOIS
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3140
Mailing Address - Country:US
Mailing Address - Phone:214-827-7460
Mailing Address - Fax:214-826-6858
Practice Address - Street 1:4144 N CENTRAL EXPY
Practice Address - Street 2:SUITE 360
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3140
Practice Address - Country:US
Practice Address - Phone:214-827-7460
Practice Address - Fax:214-826-6858
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8062207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199896505Medicaid
TX8EH350OtherBCBS TX
TX199896505Medicaid
TX8K1652Medicare PIN