Provider Demographics
NPI:1972556330
Name:JOHNSTON, ROSWELL MACCALLUM (DO)
Entity Type:Individual
Prefix:
First Name:ROSWELL
Middle Name:MACCALLUM
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DO
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 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-833-5922
Mailing Address - Fax:319-833-5923
Practice Address - Street 1:4612 PRAIRIE PKWY
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-7971
Practice Address - Country:US
Practice Address - Phone:319-472-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02197207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42141730711OtherJOHN DEERE HEALTH INS
IA1248211Medicaid
IA19260OtherWELLMARK INS PLAN
IA1248211Medicaid
IA19260OtherWELLMARK INS PLAN