Provider Demographics
NPI:1194373738
Name:BRETT C LOCKMAN DO MEDICAL CORPORATION
Entity Type:Organization
Organization Name:BRETT C LOCKMAN DO MEDICAL CORPORATION
Other - Org Name:SIERRA BIOTENSEGRITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:209-536-4776
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury MedicineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Multi-Specialty