Provider Demographics
NPI:1447467170
Name:JOHNSTON, MATTHEW W (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2954 MALLORY CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1820
Mailing Address - Country:US
Mailing Address - Phone:321-939-0222
Mailing Address - Fax:321-939-0225
Practice Address - Street 1:2954 MALLORY CIR STE 101
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-1820
Practice Address - Country:US
Practice Address - Phone:321-939-0222
Practice Address - Fax:321-939-0225
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10303207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30381OtherBLUECROSS BLUESHIELD
FLP00659065OtherMEDICARE RAILROAD
FL316379OtherAVMED
FL280946000Medicaid
FL7596334OtherCIGNA
FL9463126OtherAETNA
FLP00659065OtherMEDICARE RAILROAD