| Doctor Name: | MATTHEW A BROOM |
| NPI Number: | 1114967767 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 2006004155 |
| Business Practice Address: | 1465 S Grand Blvd St. Louis, MO - 631041003 |
| Business Phone Number: | 3142684101 |
| Business Fax Number: | 3145775379 |
| Mailing Address: | 3691 Rutger Ave, ST. LOUIS |
| State: | MO |
| Postal Code: | 631102515 |
| Phone Number: | 3149776828 |
| Fax Number: | 3149776872 |
| NPI Enumeration Date: | 06/08/2006 |
| NPI Last Update Date: | 07/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2080P0204X |
| License Number: | 2006004155 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Pediatrics |
| Taxonomy Specialization: | Pediatric Emergency Medicine |
| Taxonomy Definition: | A pediatrician who has special qualifications to manage emergencies in infants and children. |