Provider Demographics
NPI:1982866109
Name:JOHNSTON, GREGORY ROSS (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ROSS
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2200 JEFFERSON AVE
Mailing Address - Street 2:5TH FL
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7101
Mailing Address - Country:US
Mailing Address - Phone:419-251-8983
Mailing Address - Fax:
Practice Address - Street 1:3930 SUNFOREST CT
Practice Address - Street 2:100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4527
Practice Address - Country:US
Practice Address - Phone:419-251-8760
Practice Address - Fax:419-251-8765
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-29
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017786208600000X
OH34.011316208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105812Medicaid
OHH350780Medicare PIN