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Individual

GORDON A MATLOCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1615 DELAWARE ST, SUITE 100, LONGVIEW, WA 98632-2310
(360) 577-6628
Mailing address
PO BOX 2400, LONGVIEW, WA 98632-8461
(360) 577-6628

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD00017271
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1540608
WA
Enumeration date
06/11/2006
Last updated
05/03/2012
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