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1083604458

NPI Code Detail

MEDICARE: VIRGIL B MEDLOCK MD

MEDICARE: VIRGIL B MEDLOCK MD

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	207X00000X	Orthopaedic Surgery Physician	K3615	TX
2	207XS0106X	Orthopaedic Hand Surgery Physician	K3615	TX
3	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	K3615	TX
4	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	K3615	TX
5	207XX0801X	Orthopaedic Trauma Physician	K3615	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8A5019	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083604458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGIL B MEDLOCK MD

Provider Business Mailing Address
First Line	:	PO BOX 650500
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75265-0500
Country	:	US
Telephone Number	:	214-369-8555
Fax Number	:	214-369-2683

Provider Business Practice Location Address
First Line	:	3900 JUNIUS ST
Second Line	:	SUITE 500
City	:	DALLAS
State	:	TX
Zip	:	75246-1615
Country	:	US
Telephone Number	:	214-823-7090
Fax Number	:	214-823-1644

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	09/28/2012

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Directions to “ VIRGIL B MEDLOCK MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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