MEDICARE: DR. MATTHEW D JOHNSTON 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	20266	OK
2	207Q00000X	Family Medicine Physician	9824877-1205	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	500522075	OTHER	OK	MEDICARE GROUP PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982692307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW D JOHNSTON MD

Provider Business Mailing Address
First Line	:	1255 EAST 3900 SOUTH
Second Line	:	SUITE 300
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124
Country	:	US
Telephone Number	:	918-488-6001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1255 EAST 3900 SOUTH
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124
Country	:	US
Telephone Number	:	918-272-2247
Fax Number	:

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	11/16/2017

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Directions to “ DR. MATTHEW D JOHNSTON MD” Practice Location

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