Provider Demographics
NPI:1568876332
Name:JOHNSTON, ISAAC DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:DANIEL
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10824 SHAWNEE MISSION PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-3512
Mailing Address - Country:US
Mailing Address - Phone:913-297-7472
Mailing Address - Fax:913-248-7631
Practice Address - Street 1:10824 SHAWNEE MISSION PARKWAY
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-3512
Practice Address - Country:US
Practice Address - Phone:913-297-7472
Practice Address - Fax:913-248-7631
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2021039021207Q00000X
KS04-38659207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine