Organization
M & T DERMATOLOGY SERVICES LLC
Active
Organization
M & T DERMATOLOGY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK STEPHEN MATLOCK MD (OWNER)
(417) 624-0440
Entity
Organization
Contact information
Practice address
2829 S JACKSON AVE, JOPLIN, MO 64804-2525
(417) 624-0440
(417) 624-9652
Mailing address
2829 S JACKSON AVE, JOPLIN, MO 64804-2525
(417) 624-0440
(417) 624-9652
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
506068501
—
MO
01
—
DA0571
RAILROAD MEDICARE
—
Enumeration date
10/13/2005
Last updated
11/19/2008
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up