NPIMap

Organization Active NPI

Marvin P Matlock M D Inc

  • Internal Medicine Physician
  • Fresno, CA
National Provider Identifier
1346486396
Registry record updated Mar 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G30634 Issued in CA
Legal business name
MARVIN P MATLOCK M D INC
Practice address
125 E Barstow Ave
Suite 104
Fresno, CA 93710-5020
Phone
(559) 226-7107
NPI assigned
Dec 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Marvin Perry Matlock, M.D.
Title
Owner
Phone
(559) 226-7107

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X G30634 CA Primary

Addresses

Primary practice location

125 E Barstow Ave
Suite 104
Fresno, CA 93710-5020

Mailing address

125 E Barstow Ave
Suite 104
Fresno, CA 93710-5020
Phone (559) 226-7107

Other identifiers 1

IdentifierTypeStateIssuer
P0017327OtherCARAILROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

540 E Herndon Ave
Fresno, CA 93720
Phone (559) 226-7107

125 E Barstow Ave
Ste 104
Fresno, CA 93710
Phone (559) 226-7107

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237507200000",
    "number": "1346486396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 E BARSTOW AVE",
            "address_2": "SUITE 104",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937105020",
            "telephone_number": "559-226-7107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 E BARSTOW AVE",
            "address_2": "SUITE 104",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937105020",
            "telephone_number": "559-226-7107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARVIN P MATLOCK M D INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-22",
        "last_updated": "2009-03-20",
        "status": "A",
        "authorized_official_last_name": "MATLOCK",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "PERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "559-226-7107",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G30634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P0017327",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.