Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2015158 | CA |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | N0221 | TX |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 2015158 | CA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | N0221 | TX |
N | 2081P2900X | Pain Medicine | 4156 | IA |
N | 2081S0010X | Sports Medicine | 20A15158 | CA |
N | 213ES0000X | Sports Medicine | 20A15158 | CA |
N | 2081S0010X | Sports Medicine | 4156 | IA |
N | 213ES0000X | Sports Medicine | 4156 | IA |
N | 2081S0010X | Sports Medicine | N0221 | TX |
N | 213ES0000X | Sports Medicine | N0221 | TX |
NPI | 1003002742 |
---|---|
Provider Name | Brett C. Lockman |
First Address | Sonora, CA 95370-5288 |
Second Address | Sonora, CA 95370-5288 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2007 |
Last Update Date | 02/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009606357 | AETNA (01) | NC |
1542X | BCBSNC (01) | NC |
2235045 | MAMSI (01) | NC |
2915767 | UHC (01) | NC |
P00784683 | RAILROAD MEDICARE (01) | NC |