Provider Demographics
NPI:1225321441
Name:LILLIAN D LOCKETT MD PA
Entity Type:Organization
Organization Name:LILLIAN D LOCKETT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EXECUTIVE
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-299-3255
Mailing Address - Street 1:135 OYSTER CREEK DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4119
Mailing Address - Country:US
Mailing Address - Phone:979-299-3255
Mailing Address - Fax:979-299-3433
Practice Address - Street 1:135 OYSTER CREEK DR
Practice Address - Street 2:SUITE E
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4119
Practice Address - Country:US
Practice Address - Phone:979-299-3255
Practice Address - Fax:979-299-3433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1463332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034120801Medicaid
TX034120801Medicaid