Provider Demographics
NPI:1376582577
Name:JOHNSTON, GARY MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MICHAEL
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 CARONDELET DR
Mailing Address - Street 2:STE 220
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4859
Mailing Address - Country:US
Mailing Address - Phone:816-941-1600
Mailing Address - Fax:816-941-1699
Practice Address - Street 1:1010 CARONDELET DR
Practice Address - Street 2:STE 220
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4859
Practice Address - Country:US
Practice Address - Phone:816-941-1600
Practice Address - Fax:816-941-1699
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO R5613207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4534129OtherAETNA US HEALTHCARE
MO110213633OtherRAILROAD MEDICARE
MO240233429Medicaid
MO2762200003OtherCIGNA HEALTHCARE OF KANSAS/MISSOURI, INC
MO110213633OtherRAILROAD MEDICARE
MO240233429Medicaid