Provider Demographics
NPI:1467447664
Name:BRUST, MATTHEW L (MD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:L
Last Name:BRUST
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:397 WALLACE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4854
Mailing Address - Country:US
Mailing Address - Phone:615-834-6166
Mailing Address - Fax:516-781-9755
Practice Address - Street 1:397 WALLACE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4854
Practice Address - Country:US
Practice Address - Phone:615-834-6166
Practice Address - Fax:516-781-9755
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2022-02-09
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Provider Licenses
StateLicense IDTaxonomies
TNMD25829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3800427Medicaid
TN3800427Medicaid
TN3800427Medicaid