Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 0102204013 | VA |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | R6C10 | MO |
N | 207Q00000X | Family Doctor | 0102204013 | VA |
N | 207Q00000X | Family Doctor | R6C10 | MO |
NPI | 1386645968 |
---|---|
Provider Name | Dr. Michael D Lockwood |
First Address | Lynchburg, VA 24502-2101 |
Second Address | Lynchburg, VA 24502-2101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 01/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1386645968 | (05) | VA |
241744705 | (05) | MO |
E20208 | (02) | |
P00237480 | RAILRAOD MEDICARE (01) |