Matlock, Gordon A
Matlock, Gordon A is an sole proprietor health care provider with primary practice located at 1615 Delaware St Suite 100, Longview WA 98632-2310. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Matlock, Gordon A can be contacted via phone (360) 577-6628.Contact Information
Primary practice address
1615 Delaware St Suite 100
Longview WA 98632-2310
Phone: (360) 577-6628
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | MD00017271 | Washington |
Profile Details
| NPI number | 1952343543 |
|---|---|
| LBN Legal business name | Matlock, Gordon A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 11th, 2006 |
| Last updated | May 3rd, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1952343543 | NPPES |
| Washington | MEDICAID | 1540608 |
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