Individual
MR. JERRY ALBERT JOHNSTONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1201 ENTERPRISE AVE, APT 610, LAKE CITY, TX 77573
(806) 396-5583
(806) 366-2713
Mailing address
P.O. BOX 1107, STRATFORD, TX 79084
(806) 396-5583
(806) 366-2713
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01624
TX
Other
Enumeration date
02/01/2010
Last updated
02/01/2010
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