Provider Demographics
NPI:1003002742
Name:LOCKMAN, BRETT C (DO)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:C
Last Name:LOCKMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:18575 LAMBERT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9333
Mailing Address - Country:US
Mailing Address - Phone:214-766-7817
Mailing Address - Fax:833-302-0274
Practice Address - Street 1:19468 VILLAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9228
Practice Address - Country:US
Practice Address - Phone:209-536-4776
Practice Address - Fax:833-302-0274
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN0221204D00000X, 208100000X, 2081S0010X
CA2015158204D00000X, 208100000X
CA20A151582081P0301X, 2081S0010X, 208VP0014X
IA41562081P2900X, 2081S0010X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00784683OtherRAILROAD MEDICARE
NC2915767OtherUHC
NC1542XOtherBCBSNC
NC0009606357OtherAETNA
NC2235045OtherMAMSI
NC2403209Medicare PIN