Provider Demographics
NPI:1720171143
Name:DOUST, MATTHEW WEBB (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WEBB
Last Name:DOUST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5281 N 99TH AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-3105
Mailing Address - Country:US
Mailing Address - Phone:623-516-8252
Mailing Address - Fax:623-516-8253
Practice Address - Street 1:3900 E CAMELBACK RD
Practice Address - Street 2:SUITE 190
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2614
Practice Address - Country:US
Practice Address - Phone:623-516-8252
Practice Address - Fax:623-516-8253
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29037174400000X
AZ29038207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No174400000XOther Service ProvidersSpecialist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ752312Medicaid
AZ29038OtherSTATE LICENSE
AZBD7113234OtherDEA
AZ74901Medicare ID - Type Unspecified
AZ29038OtherSTATE LICENSE
AZBD7113234OtherDEA