MEDICARE: KATHERINE SUZANNE JOHNSTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A102321	CA
2	208000000X	Pediatrics Physician	MD29260	OR

General Provider Information

NPI Number	:	1184869026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE SUZANNE JOHNSTON M.D.

Provider Business Mailing Address
First Line	:	700 SW RAMSEY AVE
Second Line	:	#204
City	:	GRANTS PASS
State	:	OR
Zip	:	97527-5786
Country	:	US
Telephone Number	:	541-955-5683
Fax Number	:	541-955-0983

Provider Business Practice Location Address
First Line	:	700 SW RAMSEY AVE
Second Line	:	#204
City	:	GRANTS PASS
State	:	OR
Zip	:	97527-5786
Country	:	US
Telephone Number	:	541-955-5683
Fax Number	:	541-955-0983

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2008
Last Update Date	:	08/19/2009

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