Provider Demographics
NPI:1639142847
Name:JOHNSTON, BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
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 1:2946 E BANNER GATEWAY DR
Mailing Address - Street 2:BANNER MD ANDERSON CANCER CENTER
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2165
Mailing Address - Country:US
Mailing Address - Phone:480-543-6900
Mailing Address - Fax:480-543-6985
Practice Address - Street 1:2946 E BANNER GATEWAY DR
Practice Address - Street 2:BANNER MD ANDERSON CANCER CENTER
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2165
Practice Address - Country:US
Practice Address - Phone:480-543-6900
Practice Address - Fax:480-543-6985
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD605441072085R0202X
AZ330602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1639142847Medicaid
WA1639142847Medicaid