Provider Demographics
NPI:1104826080
Name:JOHNSTONE, JOHN MOSER (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MOSER
Last Name:JOHNSTONE
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 1:2161 LEXINGTON RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7952
Mailing Address - Country:US
Mailing Address - Phone:859-624-8647
Mailing Address - Fax:859-624-5044
Practice Address - Street 1:2161 LEXINGTON ROAD
Practice Address - Street 2:SUITE #1
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-0000
Practice Address - Country:US
Practice Address - Phone:859-624-8647
Practice Address - Fax:859-624-5044
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17876207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY609154200OtherFBL PROVIDER ID
KY64178767Medicaid
KY728301Medicare PIN
KY060069271Medicare PIN
KY609154200OtherFBL PROVIDER ID