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General NPI Number Information
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NPI Number | 1609869452
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Entity Type | Individual
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Provider Name | REGINALD DEAN LOCKLEAR PA
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Gender | Male
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 05/27/2020
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Provider Practice Location Address
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Address Line | 1610 NE MIAMI GARDENS DR
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City | MIAMI
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State | FL
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Zip | 33179-4900
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Country | US
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Telephone | 305-940-6061
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Fax | 305-940-6167
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Provider Business Mailing Address
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Address Line | 900 S PINE ISLAND RD STE 800
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City | PLANTATION
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State | FL
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Zip | 33324-3923
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Country | US
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Telephone | 305-940-6016
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Fax | 305-940-6167
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9110529
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License Number State | FL
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