MEDICARE: MATTHEW B 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	207Q00000X	Family Medicine Physician	5628325-1205	UT

General Provider Information

NPI Number	:	1699787770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW B JOHNSON M.D.

Provider Business Mailing Address
First Line	:	11966 S 2740 W
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-7617
Country	:	US
Telephone Number	:	801-878-7056
Fax Number	:

Provider Business Practice Location Address
First Line	:	3730 W 4700 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84129
Country	:	US
Telephone Number	:	801-213-9200
Fax Number	:

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	10/21/2021

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