MEDICARE: MATLOCK OBSTETRICS AND GYNECOLOGY ASSOCIATES, P.A

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	174400000X	Specialist		TX

General Provider Information

NPI Number	:	1306847140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATLOCK OBSTETRICS AND GYNECOLOGY ASSOCIATES, P.A

Provider Business Mailing Address
First Line	:	515 W MAYFIELD RD
Second Line	:	200
City	:	ARLINGTON
State	:	TX
Zip	:	76014-2083
Country	:	US
Telephone Number	:	817-468-4689
Fax Number	:	817-465-7872

Provider Business Practice Location Address
First Line	:	515 W MAYFIELD RD
Second Line	:	200
City	:	ARLINGTON
State	:	TX
Zip	:	76014-2083
Country	:	US
Telephone Number	:	817-468-4689
Fax Number	:	817-465-7872

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. JULIE ZOOK
Credential	:
Telephone Number	:	817-468-4689

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/21/2022

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