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General NPI Number Information
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NPI Number | 1356648414
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Entity Type | Organization
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Legal Business Name | PAUL MATTOX MD PC
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 501 AIRPORT DR SUITE 263
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City | FARMINGTON
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State | NM
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Zip | 87401-2652
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Country | US
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Telephone | 970-375-2111
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Fax | 970-375-2444
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Provider Business Mailing Address
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Address Line | PO BOX 478
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City | DURANGO
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State | CO
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Zip | 81302-0478
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Country | US
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Telephone | 970-375-2111
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Fax | 970-375-2444
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Authorized Official
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Title or Position | OWNER
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Name | PAUL A MATTOX
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Credential | MD
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Telephone | 970-375-2111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 9985
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License Number State | NM
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