Basic Information
| Provider Information | |||||||||
| NPI: | 1972556330 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSTON | ||||||||
| FirstName: | ROSWELL | ||||||||
| MiddleName: | MACCALLUM | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2758 | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507042758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3198335922 | ||||||||
| FaxNumber: | 3198335923 | ||||||||
| Practice Location | |||||||||
| Address1: | 4612 PRAIRIE PKWY | ||||||||
| Address2: | |||||||||
| City: | CEDAR FALLS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 506137971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3194727222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 02/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 02197 | IA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.