Basic Information
| Provider Information | |||||||||
| NPI: | 1154740132 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOHN S MATLOCK MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11503 NW MILITARY HWY | ||||||||
| Address2: | SUITE 321 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782311884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104921677 | ||||||||
| FaxNumber: | 2104921877 | ||||||||
| Practice Location | |||||||||
| Address1: | 11503 NW MILITARY HWY | ||||||||
| Address2: | SUITE 321 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782311884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104921677 | ||||||||
| FaxNumber: | 2104921877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2014 | ||||||||
| LastUpdateDate: | 04/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | MATLOCK | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2104921677 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | F5644 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.