Individual
JOSEPH M MATTOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5050 N CLINTON ST, FORT WAYNE, IN 46825-5886
(260) 484-8551
(260) 482-5060
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01051027A
IN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
01051027A
IN
2080S0010X
Pediatric Sports Medicine Physician
01051027A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11180921
CAQH
IN
05
—
200187520
—
IN
01
—
P00846132
MEDICARE RR
IN
Enumeration date
06/21/2006
Last updated
03/09/2026
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