Individual
DR. ROBERT K MATLACK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2587 RAVENHILL DR, FAYETTEVILLE, NC 28303-5451
(910) 323-1543
(910) 485-1257
Mailing address
2587 RAVENHILL DR, FAYETTEVILLE, NC 28303-5451
(910) 323-1543
(910) 485-1257
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
200201282
NC
2084P0804X
Child & Adolescent Psychiatry Physician
20021282
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1327F
BCBS
NC
01
—
2123955
CIGNA
NC
01
—
301980
MANAGED HEALTH NETWORK
NC
01
—
7448603
AETNA
NC
05
—
891327F
—
NC
Enumeration date
06/14/2005
Last updated
11/16/2009
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