Individual
DR. MATTHEW D JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1255 EAST 3900 SOUTH, SALT LAKE CITY, UT 84124
(918) 272-2247
Mailing address
1255 EAST 3900 SOUTH, SUITE 300, SALT LAKE CITY, UT 84124
(918) 488-6001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
20266
OK
207Q00000X
Family Medicine Physician
Primary
9824877-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100091330A
—
OK
01
—
500522075
MEDICARE GROUP PIN
OK
Enumeration date
10/10/2005
Last updated
11/16/2017
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