MEDICARE: MATTHEW MICHAEL JOHNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	Q9391	TX

General Provider Information

NPI Number	:	1326305236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW MICHAEL JOHNSON M.D.

Provider Business Mailing Address
First Line	:	2604 SAINT MICHAEL DR STE 425
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-2378
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 MEDICAL CIR
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-2138
Country	:	US
Telephone Number	:	903-885-1740
Fax Number	:	903-438-1134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2012
Last Update Date	:	12/16/2025

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