Provider Demographics
NPI:1760578371
Name:JOHNSON, F MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:F
Middle Name:MATTHEW
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10161 PARK RUN DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8871
Mailing Address - Country:US
Mailing Address - Phone:702-874-8807
Mailing Address - Fax:702-446-9873
Practice Address - Street 1:10161 PARK RUN DR
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-8871
Practice Address - Country:US
Practice Address - Phone:702-874-8807
Practice Address - Fax:702-446-9873
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV12571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV46-0767230OtherSTATE OF NEVADA