Provider Demographics
NPI:1144204314
Name:JOHNSTON, JAMES MILTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MILTON
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 1:1110 N CLASSEN BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-6842
Mailing Address - Country:US
Mailing Address - Phone:405-236-3736
Mailing Address - Fax:405-236-2137
Practice Address - Street 1:1110 N CLASSEN BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6842
Practice Address - Country:US
Practice Address - Phone:405-236-3736
Practice Address - Fax:405-236-2137
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9515207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100110380AMedicaid
D42535Medicare UPIN
OK100110380AMedicaid