Provider Demographics
NPI:1225272289
Name:JOHNSTON, COLLIN D (DO)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:D
Last Name:JOHNSTON
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4077 E CULLUMBER ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-0719
Mailing Address - Country:US
Mailing Address - Phone:702-803-4539
Mailing Address - Fax:
Practice Address - Street 1:1520 S DOBSON RD STE 202
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4726
Practice Address - Country:US
Practice Address - Phone:480-725-7241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ011209207Q00000X, 2086S0129X
AZ928202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1225272289Medicaid
V109066OtherMEDICARE PTAN