Provider Demographics
NPI:1205824620
Name:LOCKER, DAN L (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:L
Last Name:LOCKER
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 1:125 S PARK DR
Mailing Address - Street 2:STE A
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5952
Mailing Address - Country:US
Mailing Address - Phone:325-646-1122
Mailing Address - Fax:325-643-2999
Practice Address - Street 1:125 S PARK DR
Practice Address - Street 2:STE A
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5952
Practice Address - Country:US
Practice Address - Phone:325-646-1122
Practice Address - Fax:325-643-2999
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1026208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152895201Medicaid
TX152895201Medicaid
TX00901KMedicare PIN