Individual
KELLY MATLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1301 MONTGOMERY RD, GRAHAM, TX 76450-4240
(254) 624-7486
Mailing address
1301 MONTGOMERY RD, GRAHAM, TX 76450-4240
(254) 624-7486
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
N2643
TX
Other
Enumeration date
09/05/2008
Last updated
01/02/2014
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