Provider Demographics
NPI:1699746941
Name:JOHNSTON, SHAWN (MD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4100 LAKE OTIS PKWY
Mailing Address - Street 2:STE 216
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5230
Mailing Address - Country:US
Mailing Address - Phone:907-563-2873
Mailing Address - Fax:907-563-5852
Practice Address - Street 1:3801 UNIVERSITY LAKE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4639
Practice Address - Country:US
Practice Address - Phone:907-563-8876
Practice Address - Fax:907-762-6315
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK43322081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD9202Medicaid
AKG35298Medicare UPIN
AKMD9202Medicaid