Provider Demographics
NPI:1245218130
Name:LOCK, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:LOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:109 POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78610-9239
Mailing Address - Country:US
Mailing Address - Phone:512-262-1126
Mailing Address - Fax:512-262-1126
Practice Address - Street 1:109 POPLAR DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TX
Practice Address - Zip Code:78610-9239
Practice Address - Country:US
Practice Address - Phone:512-262-1126
Practice Address - Fax:512-262-1126
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2013-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH-4496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00310MMedicare ID - Type Unspecified
TXE04405Medicare UPIN