Provider Demographics
NPI:1558312504
Name:JOHNSTON, WALTER STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:STUART
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 1:3600 SHIRE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2236
Mailing Address - Country:US
Mailing Address - Phone:972-487-6400
Mailing Address - Fax:972-487-1686
Practice Address - Street 1:3600 SHIRE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2236
Practice Address - Country:US
Practice Address - Phone:972-487-6400
Practice Address - Fax:972-487-1686
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4238208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88720GOtherBLUE CROSS BLUE SHIELD
TX125237104Medicaid
TX88720GOtherBLUE CROSS BLUE SHIELD
TX89092FMedicare PIN