MEDICARE: DR. MIKE L LOCKLEAR M.D.

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
1	207Q00000X	Family Medicine Physician	F1755	TX
2	208D00000X	General Practice Physician	F1755	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	118000100	OTHER	TX	FIRSTCARE
2	4513443	OTHER	TX	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	121567	OTHER	TX	CHIPS
5	751839268001	OTHER	TX	TRICARE/CHAMPUS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	93842	OTHER	TX	SCOTT & WHITE HEALTH PLAN

General Provider Information

NPI Number	:	1598713174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIKE L LOCKLEAR M.D.

Provider Business Mailing Address
First Line	:	101 LAFFERTY AVE
Second Line	:
City	:	CAMERON
State	:	TX
Zip	:	76520-2551
Country	:	US
Telephone Number	:	254-605-1100
Fax Number	:	254-605-1120

Provider Business Practice Location Address
First Line	:	101 LAFFERTY AVE
Second Line	:
City	:	CAMERON
State	:	TX
Zip	:	76520-2551
Country	:	US
Telephone Number	:	254-605-1100
Fax Number	:	254-605-1120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	08/29/2013

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