Provider Demographics
NPI:1174779300
Name:BROWN, MATTHEW AUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:AUSTIN
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 13TH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-2387
Mailing Address - Country:US
Mailing Address - Phone:417-260-4150
Mailing Address - Fax:
Practice Address - Street 1:9100 13TH RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-2387
Practice Address - Country:US
Practice Address - Phone:417-260-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011010536207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1174779300Medicaid
MO205648306Medicaid
MO431560263OtherTRICARE
MOP00985958OtherRR MCR
MO26D0889777OtherCLIA