Provider Demographics
NPI:1518949593
Name:JOHNSTON, WILLIAM J (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 664056
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46266-4056
Mailing Address - Country:US
Mailing Address - Phone:317-859-3737
Mailing Address - Fax:317-859-3730
Practice Address - Street 1:610 E SOUTHPORT RD
Practice Address - Street 2:SUITE 205
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8590
Practice Address - Country:US
Practice Address - Phone:317-781-7370
Practice Address - Fax:317-782-8880
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2013-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01050898A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200206050AMedicaid
IN200206050AMedicaid
H00635Medicare UPIN