Provider Demographics
NPI:1326083064
Name:MATOOK, GEORGE M (M D)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:MATOOK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N MIDWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4320
Mailing Address - Country:US
Mailing Address - Phone:405-737-3491
Mailing Address - Fax:405-737-5956
Practice Address - Street 1:215 N MIDWEST BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4320
Practice Address - Country:US
Practice Address - Phone:405-737-3491
Practice Address - Fax:405-737-5956
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK18887207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100707240AMedicaid
OK101565200OtherDEPT OF LABOR
OK200024773OtherRAILROAD MEDICARE
OK5007198OtherAETNA
OK200024773OtherRAILROAD MEDICARE
OK5007198OtherAETNA