Provider Demographics
NPI:1821007071
Name:JOHNSTON, RICHARD REED (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:REED
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 1:1302 MARLIN CT
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-8310
Mailing Address - Country:US
Mailing Address - Phone:979-244-1889
Mailing Address - Fax:979-323-8809
Practice Address - Street 1:1302 MARLIN CT
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-8310
Practice Address - Country:US
Practice Address - Phone:979-244-1889
Practice Address - Fax:979-323-8809
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9833207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC17531Medicare UPIN