Provider Demographics
NPI:1942389416
Name:JOHNSTONE, ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:JOHNSTONE
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:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-0617
Mailing Address - Country:US
Mailing Address - Phone:620-221-8930
Mailing Address - Fax:620-221-4060
Practice Address - Street 1:1230 E 6TH AVE
Practice Address - Street 2:#D
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-3143
Practice Address - Country:US
Practice Address - Phone:620-221-8930
Practice Address - Fax:620-221-4060
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-25223208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100160240 BMedicaid
102495Medicare PIN
KS100160240 BMedicaid