Organization
RANDALL J MATOS DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL JOSEPH MATOS DPM (OWNER)
(918) 649-3777
Entity
Organization
Contact information
Practice address
1103 DEWEY AVENUE, POTEAU, OK 74953-4411
(918) 649-3777
(918) 649-3891
Mailing address
PO BOX 400, POTEAU, OK 74953-0400
(918) 649-3777
(918) 649-3891
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
193
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200199110A
—
OK
01
—
DN2101
RAILROAD MEDICARE
OK
Enumeration date
07/21/2006
Last updated
03/04/2011
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