Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A150363 | CA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 56697 | AZ |
NPI | 1770882920 |
---|---|
Provider Name | Dr. Matthew Joel Brown |
First Address | Phoenix, AZ 85050-7311 |
Second Address | Glendale, AZ 85306-4709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2011 |
Last Update Date | 16/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
56697 | (05) | AZ |