Individual
VIRGIL B MEDLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3900 JUNIUS ST, SUITE 500, DALLAS, TX 75246-1615
(214) 823-7090
(214) 823-1644
Mailing address
PO BOX 650500, DALLAS, TX 75265-0500
(214) 369-8555
(214) 369-2683
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
K3615
TX
207XS0106X
Orthopaedic Hand Surgery Physician
K3615
TX
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
K3615
TX
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
K3615
TX
207XX0801X
Orthopaedic Trauma Physician
K3615
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152255901
—
TX
05
—
152255902
—
TX
05
—
152255903
—
TX
01
—
8A5019
BCBS
TX
Enumeration date
10/26/2005
Last updated
09/28/2012
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