Individual
DOUGLAS FREDERICK JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6210 S BROADWAY AVE, TYLER, TX 75703-4413
(903) 579-2700
(903) 534-9463
Mailing address
PO BOX 9477, TYLER, TX 75711-9477
(903) 594-2450
(903) 509-0493
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
L7432
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8J0326
BLUE CROSS
TX
01
—
P00050031
MEDICARE RR
—
Enumeration date
06/28/2006
Last updated
01/03/2008
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