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General NPI Number Information
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NPI Number | 1083641559
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Entity Type | Individual
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Provider Name | DOUGLAS FREDERICK JOHNSTON DO
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 6210 S BROADWAY AVE
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City | TYLER
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State | TX
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Zip | 75703-4413
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Country | US
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Telephone | 903-579-2700
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Fax | 903-534-9463
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Provider Business Mailing Address
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Address Line | PO BOX 9477
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City | TYLER
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State | TX
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Zip | 75711-9477
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Country | US
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Telephone | 903-594-2450
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Fax | 903-509-0493
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L7432
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License Number State | TX
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