Individual
JUSTIN MICHAEL MEDLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2209 E 32ND ST, TACOMA, WA 98404-4922
(253) 593-0232
Mailing address
1007 39TH AVE SE, PUYALLUP, WA 98374-2192
(509) 241-7205
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP60668377
WA
Other
Enumeration date
05/30/2013
Last updated
11/08/2016
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