Provider Demographics
NPI:1518327089
Name:JOHNSTONE, MATHEW JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:JAMES
Last Name:JOHNSTONE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4104
Mailing Address - Country:US
Mailing Address - Phone:152-711-1731
Mailing Address - Fax:515-271-1714
Practice Address - Street 1:3200 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-4104
Practice Address - Country:US
Practice Address - Phone:152-711-1731
Practice Address - Fax:515-271-1714
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA415300059213EP0504X
IA108136213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1518327089Medicaid