Provider Demographics
NPI:1740736081
Name:MATLOCK, OSCAR LEE JR (LVN)
Entity Type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:LEE
Last Name:MATLOCK
Suffix:JR
Gender:M
Credentials:LVN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:13737 NOEL RD
Mailing Address - Street 2:1400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-1331
Mailing Address - Country:US
Mailing Address - Phone:214-712-2777
Mailing Address - Fax:877-614-6192
Practice Address - Street 1:13737 NOEL ROAD
Practice Address - Street 2:1400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:214-712-2777
Practice Address - Fax:888-491-7218
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX183341164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse