MEDICARE: JAMES W. LOCK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	12628	MS
2	207RH0005X	Hypertension Specialist Physician	12628	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00127232	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063499002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES W. LOCK MD

Provider Business Mailing Address
First Line	:	PO BOX 370
Second Line	:
City	:	WALNUT GROVE
State	:	MS
Zip	:	39189-0370
Country	:	US
Telephone Number	:	601-253-2733
Fax Number	:	601-253-2733

Provider Business Practice Location Address
First Line	:	199 RIMMER STREET
Second Line	:
City	:	WALNUT GROVE
State	:	MS
Zip	:	39189-0370
Country	:	US
Telephone Number	:	601-253-2733
Fax Number	:	601-253-2733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	06/26/2014

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Directions to “ JAMES W. LOCK MD” Practice Location

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