Provider Demographics
NPI:1407306665
Name:TIMOTHY S. JOHNSTON, M.D. PC
Entity Type:Organization
Organization Name:TIMOTHY S. JOHNSTON, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-756-2275
Mailing Address - Street 1:3349 G ST STE F
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0978
Mailing Address - Country:US
Mailing Address - Phone:209-349-8549
Mailing Address - Fax:209-580-4138
Practice Address - Street 1:3349 G ST
Practice Address - Street 2:SUITE F
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0993
Practice Address - Country:US
Practice Address - Phone:209-349-8549
Practice Address - Fax:209-580-4138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG586984Medicare PIN