Provider Demographics
NPI:1831163153
Name:JOHNSTON, STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
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 1:3417 GASTON AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2031
Mailing Address - Country:US
Mailing Address - Phone:972-993-5000
Mailing Address - Fax:972-993-5001
Practice Address - Street 1:8222 DOUGLAS AVE STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5937
Practice Address - Country:US
Practice Address - Phone:972-993-5040
Practice Address - Fax:972-993-5041
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9632207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134360010OtherMEDICAID - DALLAS
TX134360011OtherMEDICAID - TARRANT
TX134360012OtherMEDICAID - OTHER
TX134360013Medicaid
TX134360012OtherMEDICAID - OTHER
TXTXB146366OtherMEDICARE - DALLAS
TXP01047445OtherRAILROAD MEDICARE