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Individual
COLLEEN JAMES MATTOCKS
Active
Individual
COLLEEN JAMES MATTOCKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102202851
VA
207Q00000X
Family Medicine Physician
37742
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VV2490A
MEDICARE PTAN
VA
Enumeration date
05/29/2008
Last updated
12/07/2020
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