Individual
DR. SAMUEL LEWIS JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 HAWKINS DR, E315GH, IOWA CITY, IA 52242-1009
(319) 356-3689
Mailing address
200 HAWKINS DR, E315GH, IOWA CITY, IA 52242-1009
(319) 356-3689
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-114065
IL
207R00000X
Internal Medicine Physician
MD153947
OR
207RC0000X
Cardiovascular Disease Physician
036-114065
IL
207RC0000X
Cardiovascular Disease Physician
MD-4224
IA
207RC0000X
Cardiovascular Disease Physician
MD153947
OR
207RC0001X
Clinical Cardiac Electrophysiology Physician
036114065
IL
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
MD-42224
IA
207RC0001X
Clinical Cardiac Electrophysiology Physician
MD153947
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036114065
—
IL
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
206147126
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
CA4748
MEDICARE RAILROAD (GROUP PTAN)
IL
01
—
P01209465
MEDICARE RAILROAD (PROVIDER PTAN)
IL
Enumeration date
05/20/2007
Last updated
12/12/2016
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