Provider Demographics
NPI:1306847140
Name:MATLOCK OBSTETRICS AND GYNECOLOGY ASSOCIATES, P.A
Entity Type:Organization
Organization Name:MATLOCK OBSTETRICS AND GYNECOLOGY ASSOCIATES, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-468-4689
Mailing Address - Street 1:515 W MAYFIELD RD
Mailing Address - Street 2:200
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2083
Mailing Address - Country:US
Mailing Address - Phone:817-468-4689
Mailing Address - Fax:817-465-7872
Practice Address - Street 1:515 W MAYFIELD RD
Practice Address - Street 2:200
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2083
Practice Address - Country:US
Practice Address - Phone:817-468-4689
Practice Address - Fax:817-465-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R31CMedicare PIN