Provider Demographics
NPI:1497703912
Name:LOCKE, DONALD RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:RUSSELL
Last Name:LOCKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 773730
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34477-3730
Mailing Address - Country:US
Mailing Address - Phone:352-861-2115
Mailing Address - Fax:352-854-5726
Practice Address - Street 1:9401 SW HIGHWAY 200 STE 502
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-9650
Practice Address - Country:US
Practice Address - Phone:352-861-2115
Practice Address - Fax:352-854-5726
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2018-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME44759208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036144500Medicaid
FL036144500Medicaid
D83965Medicare UPIN