Gordon A Matlock, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD00017271 Issued in WA

Practice address

1615 Delaware St
Suite 100
Longview, WA 98632-2310

Phone

(360) 577-6628

NPI assigned

Jun 11, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336003200000",
    "number": "1952343543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2400",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986328461",
            "telephone_number": "360-577-6628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 DELAWARE ST",
            "address_2": "SUITE 100",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322310",
            "telephone_number": "360-577-6628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATLOCK",
        "first_name": "GORDON",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-11",
        "last_updated": "2012-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MD00017271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1540608",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christina Mason, PTA
• Linda Joan Mason
• Deana Mateo
• Cassie Annealyce Matherson
• Derek Matlock, PHARM.D.
• Matthew E Lesh DMD PC
• Christine L Matthews, PA C
• John Christopher Mattos, DMD
• Steven L Mattson, MD
• Olivia Mattus, CPC

• Specialist in Longview, WA
• Providers in Longview, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2012; 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.