Provider Demographics
NPI:1639320955
Name:JOHNSTON, OLIVER LAWERNCE (MD)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:LAWERNCE
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 1:551 LINN ST
Mailing Address - Street 2:SUITE #20
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1595
Mailing Address - Country:US
Mailing Address - Phone:268-686-5888
Mailing Address - Fax:269-686-5865
Practice Address - Street 1:551 LINN ST
Practice Address - Street 2:SUITE 20
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1595
Practice Address - Country:US
Practice Address - Phone:269-686-5888
Practice Address - Fax:269-686-5865
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301036842208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology