Provider Demographics
NPI:1295383172
Name:LOCKWOOD, TRAVIS LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LEE
Last Name:LOCKWOOD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7271 FLAMING FOREST ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-3309
Mailing Address - Country:US
Mailing Address - Phone:210-632-9119
Mailing Address - Fax:
Practice Address - Street 1:4410 MEDICAL DR STE 320
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3749
Practice Address - Country:US
Practice Address - Phone:210-874-3270
Practice Address - Fax:210-874-3271
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13016363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical