Provider Demographics
NPI:1790796977
Name:JOHNSTON, HAROLD L (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:L
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 1:3760 PIPER ST
Mailing Address - Street 2:SUITE 1060
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4665
Mailing Address - Country:US
Mailing Address - Phone:907-212-6522
Mailing Address - Fax:907-212-6593
Practice Address - Street 1:1201 E 36TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4372
Practice Address - Country:US
Practice Address - Phone:907-562-9229
Practice Address - Fax:907-562-1603
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK2411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD24111Medicaid
AK152333Medicare PIN
AKE33732Medicare UPIN
AKMD24111Medicaid