Provider Demographics
NPI:1467770917
Name:MATZINGER, JOHN DELMO (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DELMO
Last Name:MATZINGER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12407 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2475
Mailing Address - Country:US
Mailing Address - Phone:512-339-6644
Mailing Address - Fax:512-832-9128
Practice Address - Street 1:12407 N MOPAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2475
Practice Address - Country:US
Practice Address - Phone:512-339-6644
Practice Address - Fax:512-832-9128
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist