Basic Information
| Provider Information | |||||||||
| NPI: | 1811003056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSTON | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 MEMORIAL DRIVE | ||||||||
| Address2: | MEMORIAL HOSPITAL MED AFFAIRS CREDENTIALING DEPT | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182574644 | ||||||||
| FaxNumber: | 6182576946 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 MEMORIAL DR | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622265373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182349884 | ||||||||
| FaxNumber: | 6182359020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 03/21/2016 | ||||||||
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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 | 036-099381 | IL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.