Provider Demographics
NPI:1467913723
Name:LOCKHART, JONATHAN RUSSELL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:RUSSELL
Last Name:LOCKHART
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BAYLOR PLZ # MS 220
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3498
Mailing Address - Country:US
Mailing Address - Phone:423-384-1103
Mailing Address - Fax:
Practice Address - Street 1:1 BAYLOR PLZ # MS 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3498
Practice Address - Country:US
Practice Address - Phone:423-384-1103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program