Provider Demographics
NPI:1154740132
Name:JOHN S MATLOCK MD PA
Entity type:Organization
Organization Name:JOHN S MATLOCK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MATLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-492-1677
Mailing Address - Street 1:11503 NW MILITARY HWY
Mailing Address - Street 2:SUITE 321
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1884
Mailing Address - Country:US
Mailing Address - Phone:210-492-1677
Mailing Address - Fax:210-492-1877
Practice Address - Street 1:11503 NW MILITARY HWY
Practice Address - Street 2:SUITE 321
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1884
Practice Address - Country:US
Practice Address - Phone:210-492-1677
Practice Address - Fax:210-492-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5644207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty