Provider Demographics
NPI:1457484727
Name:LOCKLAIR, MATTHEW RYAN (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RYAN
Last Name:LOCKLAIR
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:DEPT OF EMERGENCY MEDICINE VANDERBILT
Mailing Address - Street 2:MEDICAL CENTER 703 OXFORD HOUSE,1313 21ST AVE SOUTH
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0001
Mailing Address - Country:US
Mailing Address - Phone:615-936-3898
Mailing Address - Fax:615-322-4374
Practice Address - Street 1:DEPT OF EMERGENCY MEDICINE VANDERBILT
Practice Address - Street 2:MEDICAL CENTER 703 OXFORD HOUSE,1313 21ST AVE SOUTH
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-936-3898
Practice Address - Fax:615-322-4374
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27981208000000X
TN43767390200000X, 207PP0204X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine