Provider Demographics
NPI:1477547651
Name:JOHNSTON, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
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 1:250 BLOSSOM ST
Mailing Address - Street 2:STE 310
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4204
Mailing Address - Country:US
Mailing Address - Phone:281-724-0190
Mailing Address - Fax:281-724-0191
Practice Address - Street 1:250 BLOSSOM ST
Practice Address - Street 2:STE 310
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4204
Practice Address - Country:US
Practice Address - Phone:281-724-0190
Practice Address - Fax:281-724-0191
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87588ZOtherHMO BLUE
TX118994602Medicaid
TX86Z066OtherBCBS
TX42165050OtherAETNA
TX080098209OtherRAILROAD MEDICARE
TX87588ZOtherHMO BLUE
TXE41377Medicare UPIN