Healthcare Provider Details

I. General information

NPI: 1982631172
Provider Name (Legal Business Name): BRIAN MARTIN MATTHYS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 NW PLATTE RD SUITE 120
RIVERSIDE MO
64150-9601
US

IV. Provider business mailing address

9701 SAGAMORE RD
LEAWOOD KS
66206-2313
US

V. Phone/Fax

Practice location:
  • Phone: 816-472-0400
  • Fax:
Mailing address:
  • Phone: 913-707-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2000152165
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: