MEDICARE: ROSWELL MACCALLUM JOHNSTON DO

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	207X00000X	Orthopaedic Surgery Physician	02197	IA

General Provider Information

NPI Number	:	1972556330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSWELL MACCALLUM JOHNSTON DO

Provider Business Mailing Address
First Line	:	PO BOX 2758
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50704-2758
Country	:	US
Telephone Number	:	319-833-5922
Fax Number	:	319-833-5923

Provider Business Practice Location Address
First Line	:	4612 PRAIRIE PKWY
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-7971
Country	:	US
Telephone Number	:	319-472-7222
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	02/04/2022

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