Provider Demographics
NPI:1528097847
Name:JOHNSTON, TIMOTHY SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2526
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-0526
Mailing Address - Country:US
Mailing Address - Phone:209-349-8459
Mailing Address - Fax:209-580-4138
Practice Address - Street 1:3349 G ST STE F
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0978
Practice Address - Country:US
Practice Address - Phone:209-349-8459
Practice Address - Fax:209-580-4138
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58698207PE0004X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G586980Medicaid
BQ040YMedicare PIN
BP333XMedicare PIN
00G586982Medicare PIN
CAA53437Medicare UPIN
CA00G586980Medicaid
BQ040ZMedicare PIN
BP333ZMedicare PIN