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Individual

MAX JOSEPH MATLOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
6839 S CANTON AVE, TULSA, OK 74136-3402
(405) 590-2913
Mailing address
6839 S CANTON AVE, TULSA, OK 74136-3402
(405) 590-2913

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
92790
OK
390200000X
Student in an Organized Health Care Education/Training Program
RN631383
PA

Other

Enumeration date
10/03/2013
Last updated
12/16/2013
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