Provider Demographics
NPI:1801908348
Name:JOHNSON, MATTHEW H (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:H
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 1:3340 NORTH CENTER ST #800
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:8TH AVENUE AND C STREET
Practice Address - Street 2:LDS HOSPITAL
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5892352-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1502954OtherUMWA
UT2090168OtherUNITED HEALTHCARE
UT58923521200001OtherBCBS
NV100506593Medicaid
UT107038442101OtherIHC
WY121333400Medicaid
UTQM0000075886OtherALTIUS
UT870545614MJNOtherEDUCATORS MUTUAL
UTQMP000003262249OtherMOLINA
UT83767OtherPEHP
AZ948763Medicaid
ID807208900Medicaid
UT902486OtherDESERET MUTUAL
UT99465OtherHEALTHY U
UT870545614MJNOtherEDUCATORS MUTUAL
UTP00248753Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AZ948763Medicaid