Provider Demographics
NPI:1356009179
Name:JOHNSTON, PAUL ALLEN (THW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ALLEN
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:THW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 RYAN DR SE STE 200
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-5157
Mailing Address - Country:US
Mailing Address - Phone:503-371-7701
Mailing Address - Fax:
Practice Address - Street 1:2995 RYAN DR SE STE 200
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5157
Practice Address - Country:US
Practice Address - Phone:503-371-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist