Provider Demographics
NPI:1316189921
Name:BROWN, MATTHEW STEVEN (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:STEVEN
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 1:1 PARKS LEGADO CT
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-2542
Mailing Address - Country:US
Mailing Address - Phone:432-332-2663
Mailing Address - Fax:432-337-0910
Practice Address - Street 1:1 PARKS LEGADO CT
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-2542
Practice Address - Country:US
Practice Address - Phone:432-332-2663
Practice Address - Fax:432-337-0910
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301106910390200000X
TXQ40502082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program