Provider Demographics
NPI:1093731846
Name:JOHNSTON, DAVID KEITH (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KEITH
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 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-4950
Mailing Address - Fax:859-258-4618
Practice Address - Street 1:1221 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-4950
Practice Address - Fax:859-258-4618
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37917207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYASC 1019OtherASC MEDICARE GROUP#
KYCNO474OtherRR MEDICARE GROUP#
KY3600818OtherASC MEDICAID GROUP#
KY37903705OtherMEDICAID LAB GROUP#
KY4000501OtherMEDICARE LAB GROUP#
KY64069990Medicaid
KYASC 1019OtherASC MEDICARE GROUP#
H85511Medicare UPIN