Provider Demographics
NPI:1265852685
Name:LOCKLEAR, AARON MAURICE (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:MAURICE
Last Name:LOCKLEAR
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:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28353-1847
Mailing Address - Country:US
Mailing Address - Phone:910-291-7160
Mailing Address - Fax:910-291-7180
Practice Address - Street 1:410D S JONES ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7261
Practice Address - Country:US
Practice Address - Phone:910-521-4462
Practice Address - Fax:910-521-7739
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1265852685Medicaid
SCNC3095Medicaid