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General NPI Number Information
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NPI Number | 1558055186
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Entity Type | Organization
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Legal Business Name | MATHEW S JOHNSON MD PLLC
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 2578 CAYENNE LN
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City | SHALIMAR
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State | FL
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Zip | 32579-1268
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Country | US
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Telephone | 520-409-8320
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Fax |
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Provider Business Mailing Address
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Address Line | 2578 CAYENNE LN
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City | SHALIMAR
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State | FL
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Zip | 32579-1268
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Country | US
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Telephone | 520-409-8320
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MATTHEW JOHNSON
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Credential | MD
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Telephone | 702-719-9059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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