MEDICARE: F MATTHEW JOHNSON MD

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	12571	NV

General Provider Information

NPI Number	:	1760578371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	F MATTHEW JOHNSON MD

Provider Business Mailing Address
First Line	:	10161 PARK RUN DR
Second Line	:	SUITE 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-8871
Country	:	US
Telephone Number	:	702-874-8807
Fax Number	:	702-446-9873

Provider Business Practice Location Address
First Line	:	10161 PARK RUN DR
Second Line	:	SUITE 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-8871
Country	:	US
Telephone Number	:	702-874-8807
Fax Number	:	702-446-9873

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	12/12/2014

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