Basic Information
| Provider Information | |||||||||
| NPI: | 1154428159 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSTON | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2055 NORMANDIE DR | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361112732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342696337 | ||||||||
| FaxNumber: | 3348340657 | ||||||||
| Practice Location | |||||||||
| Address1: | 2731 NIAZUMA AVE S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352052560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019064660 | ||||||||
| FaxNumber: | 2055925211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 10/18/2016 | ||||||||
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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 | 2085R0202X | 27435 | AL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | MD27435 | AL | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 051536602 | 01 | AL | BLUE CROSS BLUE SHIELD OF ALABAMA | OTHER | P00422295 | 01 | MEDICARE RAILROAD | OTHER |