Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 17930 | SC |
N | 208600000X | Surgeon | 17930 | SC |
N | 208200000X | Surgeon | MD35383 | TN |
N | 208600000X | Surgeon | MD35383 | TN |
Y | 2086X0206X | Surgical Oncologist | 17930 | SC |
NPI | 1467447359 |
---|---|
Provider Name | Mark A Lockett |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-8908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 16/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G34329 | (02) |