MEDICARE: DR. MATTHEW STEPHEN PROPST MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080S0010X	Pediatric Sports Medicine Physician	57.029124	OH
2	2080S0010X	Pediatric Sports Medicine Physician	01078341A	IN
3	2080S0010X	Pediatric Sports Medicine Physician	50455	KY
4	208000000X	Pediatrics Physician	R1441	TX
5	2080S0010X	Pediatric Sports Medicine Physician	R1441	TX

General Provider Information

NPI Number	:	1669882676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW STEPHEN PROPST MD

Provider Business Mailing Address
First Line	:	2803 EARL RUDDER FWY S
Second Line	:	STE 103
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-6099
Country	:	US
Telephone Number	:	513-803-0262
Fax Number	:	513-636-6374

Provider Business Practice Location Address
First Line	:	2800 WINSLOW AVE # 3100
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1144
Country	:	US
Telephone Number	:	513-636-4366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	07/21/2022

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