MEDICARE: DALE A LOCKHERT 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	207R00000X	Internal Medicine Physician	2000150390	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659369635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE A LOCKHERT M.D.

Provider Business Mailing Address
First Line	:	105 E WASHINGTON ST
Second Line	:
City	:	KENNETT
State	:	MO
Zip	:	63857-2041
Country	:	US
Telephone Number	:	873-888-1137
Fax Number	:	573-888-0920

Provider Business Practice Location Address
First Line	:	1870 BAGNELL DAM BLVD
Second Line	:
City	:	LAKE OZARK
State	:	MO
Zip	:	65049
Country	:	US
Telephone Number	:	573-365-2318
Fax Number	:	573-365-3009

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	12/17/2018

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Directions to “ DALE A LOCKHERT M.D.” Practice Location

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