=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386746485
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JERREL R LOCHNER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2006
-----------------------------------------------------
Last Update Date | 02/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9631 N NEVADA ST STE 300
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99218-1193
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-489-4040
-----------------------------------------------------
Fax | 509-489-9190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 406 E ROWAN AVE SUITE 200
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99207-1243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-489-4040
-----------------------------------------------------
Fax | 509-489-9190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD00016127
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------