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General NPI Number Information
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NPI Number | 1598713174
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Entity Type | Individual
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Provider Name | MIKE L LOCKLEAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 101 LAFFERTY AVE
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City | CAMERON
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State | TX
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Zip | 76520-2551
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Country | US
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Telephone | 254-605-1100
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Fax | 254-605-1120
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Provider Business Mailing Address
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Address Line | 101 LAFFERTY AVE
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City | CAMERON
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State | TX
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Zip | 76520-2551
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Country | US
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Telephone | 254-605-1100
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Fax | 254-605-1120
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F1755
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | F1755
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License Number State | TX
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