NPI 1114967767 · live from the CMS NPI Registry
Matthew A Broom, MD
Pediatrics in St. Louis, MO. National Provider Identifier 1114967767, active.
NPI record
| NPI | 1114967767 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Pediatrics 208000000X |
| Practice location | 1465 S Grand Blvd, St. Louis, MO 63104 |
| Practice phone | 314-268-4070 |
| Mailing address | 1465 S Grand Blvd, Saint Louis, MO 63104 |
| Enumerated | June 8, 2006 |
| Last updated | July 28, 2023 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatrics, Pediatric Emergency Medicine | 2080P0204X | 2006004155 (MO) |
| Pediatrics primary | 208000000X | 2006004155 (MO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.