Individual
MATTHEW WALLACE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6640 KANIKSU ST, BONNERS FERRY, ID 83805-7532
(208) 267-3141
Mailing address
6640 KANIKSU ST, BONNERS FERRY, ID 83805-7532
(208) 267-3141
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
335074
LA
207P00000X
Emergency Medicine Physician
Primary
9171859
ID
207R00000X
Internal Medicine Physician
9171859
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2524046
—
LA
Enumeration date
02/26/2018
Last updated
03/17/2026
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