Provider Demographics
NPI:1548228133
Name:JOHNSTON, DAVID P JR (M D)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:JOHNSTON
Suffix:JR
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11945 SAN JOSE BLVD
Mailing Address - Street 2:BLDG 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-399-1717
Practice Address - Street 1:2 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 500
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4763
Practice Address - Country:US
Practice Address - Phone:904-389-8861
Practice Address - Fax:904-389-5820
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24837208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
15312OtherBCBS FL
3200365OtherCIGNA
4045331OtherAETNA
FL020030075OtherRAILROAD MEDICARE
212990OtherAVMED
D52514Medicare UPIN
15312OtherBCBS FL