Provider Demographics
NPI:1184824138
Name:JOHN EDWARD LOCKYER
Entity Type:Organization
Organization Name:JOHN EDWARD LOCKYER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LOCKYER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:940-325-0778
Mailing Address - Street 1:505 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-5207
Mailing Address - Country:US
Mailing Address - Phone:940-325-0778
Mailing Address - Fax:940-328-1092
Practice Address - Street 1:505 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-5207
Practice Address - Country:US
Practice Address - Phone:940-325-0778
Practice Address - Fax:940-328-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088P213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5821061OtherAETNA
TX8V1530OtherBLUE CROSS BLUE SHIELD
TX018629801Medicaid
TX018629801Medicaid