Healthcare Provider Details

I. General information

NPI: 1912990458
Provider Name (Legal Business Name): SCOTT L JOHNSTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date: 03/23/2006
Reactivation Date: 04/03/2006

III. Provider practice location address

801 E 4TH ST STE 20
GILLETTE WY
82716-4061
US

IV. Provider business mailing address

PO BOX 689
WRIGHT WY
82732-0689
US

V. Phone/Fax

Practice location:
  • Phone: 307-686-2600
  • Fax: 307-686-2602
Mailing address:
  • Phone: 307-660-8699
  • Fax: 307-686-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6083A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: