Matthew A Broom
Pediatrician Pediatric Emergency Doctor
1465 S Grand Blvd
StLouis
, Missouri 63104-1003
Matthew A Broom
Pediatrician Pediatric Emergency Doctor
1465 S Grand Blvd
StLouis
, Missouri 63104-1003
(314) 268-4021
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About
Features
Specialties
- Pediatrician
- Pediatric Emergency Doctor
Languages spoken
- English
Location
First Address
- Matthew A Broom
- 1465 S Grand Blvd
- Saint Louis, MO
- Zip : 63104-1003
- Fax : (314) 268-4021
- Phone : (314) 268-4070
Second Address
- Matthew A Broom
- 1465 S Grand Blvd
- St. Louis, MO
- Zip : 63104-1003
- Fax : (314) 268-4021
- Phone : (314) 268-4070
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208000000X | Pediatrician | 2006004155 | MO |
| N | 2080P0204X | Pediatric Emergency Doctor | 2006004155 | MO |
National Provider Identifier
| NPI | 1114967767 |
|---|---|
| Provider Name | Matthew A Broom |
| First Address | Saint Louis, MO 63104-1003 |
| Second Address | St. Louis, MO 63104-1003 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 08/06/2006 |
| Last Update Date | 18/01/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.