Provider Demographics
NPI:1982631172
Name:MATTHYS, BRIAN MARTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MARTIN
Last Name:MATTHYS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 SAGAMORE RD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-2313
Mailing Address - Country:US
Mailing Address - Phone:913-707-5990
Mailing Address - Fax:
Practice Address - Street 1:1805 NW PLATTE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:RIVERSIDE
Practice Address - State:MO
Practice Address - Zip Code:64150-9601
Practice Address - Country:US
Practice Address - Phone:816-472-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000152165207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH19370Medicare UPIN
MOH19370Medicare UPIN