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NPI Code Detail

MEDICARE: DR. KENNETH DUDLEY LOCKE DO

MEDICARE: DR. KENNETH DUDLEY LOCKE DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician3072AZ

General Provider Information

NPI Number : 1518947886
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH DUDLEY LOCKE DO
Provider Business Mailing Address
First Line : 1660 E LAKESIDE DR # 391
Second Line :
City : BULLHEAD CITY
State : AZ
Zip : 86442-6544
Country : US
Telephone Number : 702-449-5031
Fax Number :
Provider Business Practice Location Address
First Line : 5330 S HIGHWAY 95
Second Line :
City : FORT MOHAVE
State : AZ
Zip : 86426-9225
Country : US
Telephone Number : 928-788-7069
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2006
Last Update Date : 07/08/2007

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Directions to “ DR. KENNETH DUDLEY LOCKE DO” Practice Location

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