Individual
GREGORY A MATLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3600 30TH ST, DES MOINES, IA 50310-5753
(515) 699-5999
Mailing address
3600 30TH ST, DES MOINES, IA 50310-5753
(515) 699-5999
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02860
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080178754
RR MEDICARE
IA
05
—
2121640
—
IA
05
—
3121640
—
IA
05
—
4121640
—
IA
Enumeration date
01/06/2006
Last updated
12/12/2012
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