Provider Demographics
NPI:1518002427
Name:JOHNSTON, TIM (MD)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:
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 1:2640 E BARNETT RD
Mailing Address - Street 2:E333
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4301
Mailing Address - Country:US
Mailing Address - Phone:541-282-6770
Mailing Address - Fax:541-282-6771
Practice Address - Street 1:2825 E BARNETT ROAD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-0001
Practice Address - Country:US
Practice Address - Phone:541-282-6770
Practice Address - Fax:541-282-6771
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44060207Q00000X
ORMD27527207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR241511Medicaid
OR241511Medicaid