Healthcare Provider Details

I. General information

NPI: 1225272289
Provider Name (Legal Business Name): COLLIN D JOHNSTON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S DOBSON RD STE 202
MESA AZ
85202-4726
US

IV. Provider business mailing address

4077 E CULLUMBER ST
GILBERT AZ
85234-0719
US

V. Phone/Fax

Practice location:
  • Phone: 480-725-7241
  • Fax:
Mailing address:
  • Phone: 702-803-4539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number011209
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number011209
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number928
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: