Provider Demographics
NPI:1992844708
Name:JOHNSTON, LELAND MANN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:MANN
Last Name:JOHNSTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1740 SUMAC AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-0814
Mailing Address - Country:US
Mailing Address - Phone:720-565-1422
Mailing Address - Fax:866-849-7805
Practice Address - Street 1:1740 SUMAC AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-0814
Practice Address - Country:US
Practice Address - Phone:720-565-1422
Practice Address - Fax:866-849-7805
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO384582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC510608Medicare PIN