Individual
DR. MICHAEL DEAN MEDLOCK
Active
Individual
DR. MICHAEL DEAN MEDLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
79690
MA
208000000X
Pediatrics Physician
79690
MA
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
79690
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11000546A
—
MA
Enumeration date
11/07/2005
Last updated
11/18/2022
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