Basic Information
| Provider Information | |||||||||
| NPI: | 1407306665 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TIMOTHY S. JOHNSTON, M.D. PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3349 G ST STE F | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953400978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093498549 | ||||||||
| FaxNumber: | 2095804138 | ||||||||
| Practice Location | |||||||||
| Address1: | 3349 G ST | ||||||||
| Address2: | SUITE F | ||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953400993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093498549 | ||||||||
| FaxNumber: | 2095804138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2016 | ||||||||
| LastUpdateDate: | 04/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSTON | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/OPERATOR | ||||||||
| AuthorizedOfficialTelephone: | 2097562275 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G58698 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.