Provider Demographics
NPI:1417342353
Name:MATLOCK, LAURA A (DO)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:MATLOCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 LEROY ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601
Mailing Address - Country:US
Mailing Address - Phone:330-888-9375
Mailing Address - Fax:
Practice Address - Street 1:2640 BIEHN ST STE 1
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601
Practice Address - Country:US
Practice Address - Phone:541-205-6890
Practice Address - Fax:541-205-6899
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1710207V00000X
AZ008025207V00000X
390200000X
ORDO205865207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program