Provider Demographics
NPI:1467490334
Name:LOCKABY, ANTHONY WAYNE (MS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:WAYNE
Last Name:LOCKABY
Suffix:
Gender:M
Credentials:MS, PA-C
Other - Prefix:
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Mailing Address - Street 1:763 E US HIGHWAY 80 STE 100
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8675
Mailing Address - Country:US
Mailing Address - Phone:972-564-0711
Mailing Address - Fax:972-564-0323
Practice Address - Street 1:763 E US HIGHWAY 80 STE 100
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8675
Practice Address - Country:US
Practice Address - Phone:972-564-0711
Practice Address - Fax:972-564-0323
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01828363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS56143Medicare UPIN
TX8K1921Medicare PIN