NPI
Matthew Wallace Johnson
This page is a copy of the public NPPES file.
Facts
- Status
- Active
- Credential
- DO
- Type
- Individual
- Enumeration date
- 2018-02-26
- Last updated
- 2026-09-22
Specialties
Licenses
- License ID
- 9171859
- License LA
- 335074
- License ID
- 9171859
Location
- Practice location
- 6640 Kaniksu St
- City
- Bonners Ferry ID
- Postal code
- 83805-7532
- Phone
- (208) 267-3141
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
No exclusion found for this NPI in the OIG LEIE file dated October 9, 2026. OIG's online search is the official check.
Nearby
Other NPIs in Bonners Ferry, ID. 199 records in the public file.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.
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