Provider Demographics
NPI:1992765838
Name:MATLOCK, DANIEL SCOTT (CRNA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:SCOTT
Last Name:MATLOCK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3650 W ROCK CREEK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2202
Mailing Address - Country:US
Mailing Address - Phone:405-701-3418
Mailing Address - Fax:405-701-3451
Practice Address - Street 1:3650 W ROCK CREEK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2202
Practice Address - Country:US
Practice Address - Phone:405-701-3418
Practice Address - Fax:405-701-3451
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKR0064933367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200077660AMedicaid
OK200077660AMedicaid