Basic Information
| Provider Information | |||||||||
| NPI: | 1184693608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSTON | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | EDWIN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5350 FRANTZ RD | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430164259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145446355 | ||||||||
| FaxNumber: | 6145446350 | ||||||||
| Practice Location | |||||||||
| Address1: | 5131 BEACON HILL RD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432284442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145441837 | ||||||||
| FaxNumber: | 6145442816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 08/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 34 00 1146 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0048095 | 05 | OH | MEDICAID |