Healthcare Provider Details

I. General information

NPI: 1235397233
Provider Name (Legal Business Name): JOHN LOCKHART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105
US

IV. Provider business mailing address

PO BOX 5371 M/S OA.9.120,
SEATTLE WA
98145-5005
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-5510
  • Fax:
Mailing address:
  • Phone: 206-987-6570
  • Fax: 206-987-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57-013928
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60359462
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberMD60359462
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: