Healthcare Provider Details

I. General information

NPI: 1093731846
Provider Name (Legal Business Name): DAVID KEITH JOHNSTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S BROADWAY
LEXINGTON KY
40504-2701
US

IV. Provider business mailing address

1221 S BROADWAY
LEXINGTON KY
40504-2701
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-4950
  • Fax: 859-258-4618
Mailing address:
  • Phone: 859-258-4950
  • Fax: 859-258-4618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number37917
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: