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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST
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JOHNSTON, MATTHEW DEE
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This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
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| Practice Address: |
ICON HEALTH SCIENCES
1255 EAST 3900 SOUTH
SALT LAKE CITY UT 84124
Address last updated on 6/28/2024 |
| Phone #: |
(801) 269-8200 |
| Fax #: |
(801) 904-4401 |
| County: |
NOT OKLAHOMA |
| License: |
20266 |
| Dated: |
7/10/1997 |
| Expires: |
7/1/2025 |
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Training
Issued:
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7/1/1996 |
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Training
Expires:
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8/1/1997 |
| License Type: |
Medical Doctor |
| Specialty: |
Family Medicine |
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| Status: |
Active |
| Status Class: |
Fully Licensed |
| Restricted to: |
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| Registered to Dispense: |
NO |
| Medical School: |
Baylor Coll Of Med, Houston Tx 77030 |
| Graduated: |
6 /
1996 |
| CME Year: |
2027 |
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Pending and/or Past Disciplinary Actions:
No Disciplinary Action Taken.
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All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
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| Certifications: |
AMERICAN BOARD OF FAMILY MEDICINE |
| New Patients: |
No |
| Medicaid: |
Yes |
| Medicare: |
Yes |
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| HMO/PPO: |
Aetna HMO
Aetna PPO
BlueChoice PPO
BlueLincs HMO
CIGNA HMO
CIGNA PPO
CommunityCare HMO, Inc
CommunityCare Senior HMO
Great West Healthcare
HealthChoice
Preferred Community Choice
Prudential Health Care Plan, Inc
United Healthcare HMO
United Healthcare Options PPO
Worknet of Oklahoma |
| Hospital Privileges: |
None listed |
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