Provider Demographics
NPI:1649272907
Name:JOHNSTON, ROBERT D (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
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 1:11006 SPENCER HWY
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571
Mailing Address - Country:US
Mailing Address - Phone:281-470-2100
Mailing Address - Fax:281-867-8219
Practice Address - Street 1:11006 SPENCER HWY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571
Practice Address - Country:US
Practice Address - Phone:281-470-2100
Practice Address - Fax:281-867-8219
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12806502Medicaid
TX12806502Medicaid
TXE18037Medicare UPIN