Provider Demographics
NPI:1326426883
Name:LOCKRIDGE, WILLIAM
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:LOCKRIDGE
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 1:13486 EXOTICA LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8507
Mailing Address - Country:US
Mailing Address - Phone:561-232-0924
Mailing Address - Fax:
Practice Address - Street 1:13486 EXOTICA LN
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8507
Practice Address - Country:US
Practice Address - Phone:561-232-0924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152773207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01140427Medicare UPIN