Provider Demographics
NPI:1780284729
Name:ADCOCK, MATTHEW (MICROPIGMENTOLOGIST)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ADCOCK
Suffix:
Gender:M
Credentials:MICROPIGMENTOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-3118
Mailing Address - Country:US
Mailing Address - Phone:918-844-4401
Mailing Address - Fax:
Practice Address - Street 1:7035 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3000
Practice Address - Country:US
Practice Address - Phone:918-863-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1781246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical