Healthcare Provider Details

I. General information

NPI: 1508809914
Provider Name (Legal Business Name): MATTHEW S BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 AVIATION WAY
CALDWELL ID
83605-1154
US

IV. Provider business mailing address

PO BOX 190930
BOISE ID
83719-0930
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-7100
  • Fax: 208-302-7189
Mailing address:
  • Phone: 208-367-5170
  • Fax: 208-367-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM7233
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: