Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 012970 | OH |
NPI | 1033789920 |
---|---|
Provider Name | Dennis Roy Lockaby JR. |
First Address | Sardinia, OH 45171-9404 |
Second Address | Cincinnati, OH 45246-3941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2021 |
Last Update Date | 01/07/2021 |