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General NPI Number Information
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NPI Number | 1780284729
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Entity Type | Individual
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Provider Name | MATTHEW ADCOCK MICROPIGMENTOLOGIST
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Gender | Male
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 7035 S MEMORIAL DR
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City | TULSA
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State | OK
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Zip | 74133-3000
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Country | US
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Telephone | 918-340-8718
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Fax |
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Provider Business Mailing Address
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Address Line | 2415 E 22ND ST
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City | TULSA
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State | OK
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Zip | 74114-3118
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Country | US
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Telephone | 918-844-4401
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZA2600X
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Taxonomy Name | Medical Art Specialist/Technologist
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License Number | 1781
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 210707
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License Number State | OK
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