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General NPI Number Information
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NPI Number | 1760578371
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Entity Type | Individual
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Provider Name | F MATTHEW JOHNSON MD
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 10161 PARK RUN DR SUITE 150
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City | LAS VEGAS
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State | NV
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Zip | 89145-8871
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Country | US
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Telephone | 702-874-8807
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Fax | 702-446-9873
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Provider Business Mailing Address
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Address Line | 10161 PARK RUN DR SUITE 150
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City | LAS VEGAS
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State | NV
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Zip | 89145-8871
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Country | US
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Telephone | 702-874-8807
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Fax | 702-446-9873
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12571
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License Number State | NV
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