Healthcare Provider Details

I. General information

NPI: 1407161128
Provider Name (Legal Business Name): BRUCE A. LOCKWOOD, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 OAKRIDGE DR SUITE 130
FORT COLLINS CO
80525-5564
US

IV. Provider business mailing address

1300 OAKRIDGE DR SUITE 130
FORT COLLINS CO
80525-5564
US

V. Phone/Fax

Practice location:
  • Phone: 970-377-9555
  • Fax:
Mailing address:
  • Phone: 970-377-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG88661
License Number StateCA

VIII. Authorized Official

Name: SHANDEL SCHRODER
Title or Position: BILLING MANAGER
Credential:
Phone: 303-922-4636