Provider Demographics
NPI:1851780183
Name:KINGFISHER CLINIC PLLC
Entity Type:Organization
Organization Name:KINGFISHER CLINIC PLLC
Other - Org Name:KINGFISHER FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-407-3018
Mailing Address - Street 1:1100 HOSPITAL CIR
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-5001
Mailing Address - Country:US
Mailing Address - Phone:281-407-3018
Mailing Address - Fax:
Practice Address - Street 1:1100 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-5001
Practice Address - Country:US
Practice Address - Phone:281-407-3018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty