Provider Demographics
NPI:1215365846
Name:LOCKHART, JAMAR MAURICE
Entity Type:Individual
Prefix:MR
First Name:JAMAR
Middle Name:MAURICE
Last Name:LOCKHART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 W ELM AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4751
Mailing Address - Country:US
Mailing Address - Phone:580-278-5797
Mailing Address - Fax:
Practice Address - Street 1:1208 W ELM AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4751
Practice Address - Country:US
Practice Address - Phone:580-278-5797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor