Provider Demographics
NPI:1366648123
Name:BROADWATER-HOLLIFIELD, MATTHEW BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRIAN
Last Name:BROADWATER-HOLLIFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MATTHEW
Other - Middle Name:BRIAN
Other - Last Name:HOLLIFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:952 E 2ND ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5324
Mailing Address - Country:US
Mailing Address - Phone:562-505-7714
Mailing Address - Fax:
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-3500
Practice Address - Fax:310-782-1763
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98282207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine