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NPI Code Detail

MEDICARE: GREGORY A MATLOCK DO

MEDICARE: GREGORY A MATLOCK DO
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
1207Q00000XFamily Medicine Physician02860IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2080178754OTHERIARR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396723623
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY A MATLOCK DO
Provider Business Mailing Address
First Line : 3600 30TH ST
Second Line :
City : DES MOINES
State : IA
Zip : 50310-5753
Country : US
Telephone Number : 515-699-5999
Fax Number :
Provider Business Practice Location Address
First Line : 3600 30TH ST
Second Line :
City : DES MOINES
State : IA
Zip : 50310-5753
Country : US
Telephone Number : 515-699-5999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2006
Last Update Date : 12/12/2012

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