MEDICARE: G. GILBERT JOHNSTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	MD00019180	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0191194	OTHER	WA	STATE L&I
2	8905937	OTHER	WA	CRIME VICTIMS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720020043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	G. GILBERT JOHNSTON MD

Provider Business Mailing Address
First Line	:	1802 YAKIMA AVE STE 102
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-5303
Country	:	US
Telephone Number	:	253-272-7777
Fax Number	:	253-426-4142

Provider Business Practice Location Address
First Line	:	1802 YAKIMA AVE STE 102
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-5303
Country	:	US
Telephone Number	:	253-272-7777
Fax Number	:	253-426-4142

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	05/11/2011

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