Healthcare Provider Details

I. General information

NPI: 1508806704
Provider Name (Legal Business Name): SCOTT A LOCKWOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S CLIFF AVE
SIOUX FALLS SD
57105-1005
US

IV. Provider business mailing address

2871 E OLD ORCHARD TRL
SIOUX FALLS SD
57103-4369
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-7246
  • Fax: 605-322-2891
Mailing address:
  • Phone: 605-334-2454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number3564
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: