Provider Demographics
NPI:1225272289
Name:JOHNSTON, COLLIN D (DO)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:D
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14044 W CAMELBACK RD STE 226
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-9426
Mailing Address - Country:US
Mailing Address - Phone:623-233-1050
Mailing Address - Fax:623-248-6952
Practice Address - Street 1:14044 W CAMELBACK RD STE 226
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-9426
Practice Address - Country:US
Practice Address - Phone:623-233-1050
Practice Address - Fax:623-248-6952
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0091762086S0129X, 2086S0129X
AZ928202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1225272289Medicaid
V109066OtherMEDICARE PTAN