Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 3266 | AZ |
NPI | 1003049198 |
---|---|
Provider Name | John Edward Lockhart |
First Address | Buckeye, AZ 85396-3625 |
Second Address | Phoenix, AZ 85007-3002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2009 |
Last Update Date | 24/08/2009 |