MEDICARE: DR. JOHN PATRICK MATLOCK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider	L3011	TX
2	171000000X	Military Health Care Provider	MD00036726	WA

General Provider Information

NPI Number	:	1134102437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PATRICK MATLOCK M.D.

Provider Business Mailing Address
First Line	:	WILLIAM BEAUMONT ARMY MED CTR, ATTN: CREDENTIALS OFFICE
Second Line	:	5005 NORTH PIEDRAS STREET
City	:	EL PASO
State	:	TX
Zip	:	79920-5001
Country	:	US
Telephone Number	:	915-569-1382
Fax Number	:

Provider Business Practice Location Address
First Line	:	WILLIAM BEAUMONT ARMY MEDICAL CENTER
Second Line	:	5005 NORTH PIEDRAS STREET
City	:	EL PASO
State	:	TX
Zip	:	79920-5001
Country	:	US
Telephone Number	:	915-569-1455
Fax Number	:	915-569-1432

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/08/2007

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