Individual
DR. BRAD M JOHNSTON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3707 NEW VISION DR, FORT WAYNE, IN 46895-5602
(260) 471-9466
(260) 484-5919
Mailing address
3707 NEW VISION DR, FORT WAYNE, IN 46845-1702
(260) 969-1124
(614) 210-1886
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01056073A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000362157
ANTHEM
IN
05
—
200491720
—
IN
Enumeration date
05/22/2006
Last updated
04/05/2019
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