Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DE00010657 | WA |
NPI | 1114118536 |
---|---|
Provider Name | Dr. Jeffrey Lynd Lockwood |
First Address | Spokane, WA 99208-4277 |
Second Address | Spokane, WA 99208-4277 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 09/08/2007 |