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General NPI Number Information
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NPI Number | 1912990458
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Entity Type | Individual
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Provider Name | SCOTT L JOHNSTON MD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 801 E 4TH ST STE 20
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City | GILLETTE
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State | WY
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Zip | 82716-4061
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Country | US
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Telephone | 307-686-2600
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Fax | 307-686-2602
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Provider Business Mailing Address
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Address Line | PO BOX 689
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City | WRIGHT
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State | WY
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Zip | 82732-0689
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Country | US
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Telephone | 307-660-8699
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Fax | 307-686-2602
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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 | 6083A
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License Number State | WY
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