Provider Demographics
NPI:1114972262
Name:LOCKLEAR, ROBERT W (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:LOCKLEAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 E ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-3581
Mailing Address - Country:US
Mailing Address - Phone:423-639-3330
Mailing Address - Fax:423-639-3342
Practice Address - Street 1:895 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-3581
Practice Address - Country:US
Practice Address - Phone:423-639-3330
Practice Address - Fax:423-639-3342
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNME37031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507979Medicaid
TN1507979Medicaid
TNP00415878Medicare PIN
H39145Medicare UPIN
TN38797201Medicare PIN