Provider Demographics
NPI:1528177367
Name:JOHNSTON, JAMES MARTIN (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MARTIN
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 1:850 HARVARD WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2055
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:75 PRINGLE WAY STE 505
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1469
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-3900
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0598012080P0207X
NV174472080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA404279OtherWELLCARE
GA792665328EMedicaid
11566679OtherCAQH
GA792665328CMedicaid
SCG59801Medicaid
GAP00414570OtherRAILROAD MEDICARE
GA01067533OtherAMERIGROUP
GA792665328BMedicaid
GA792665328DMedicaid
GA792665328AMedicaid
GA792665328BMedicaid
F09399Medicare UPIN