Provider Demographics
NPI:1508806704
Name:LOCKWOOD, SCOTT A (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:LOCKWOOD
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 1:2871 E OLD ORCHARD TRL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4369
Mailing Address - Country:US
Mailing Address - Phone:605-334-2454
Mailing Address - Fax:
Practice Address - Street 1:1301 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1005
Practice Address - Country:US
Practice Address - Phone:605-322-7246
Practice Address - Fax:605-322-2891
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3564207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2F818LOOtherBLUE SHIELD
IA984625Medicaid
SD0002152OtherBLUE SHIELD
MN532507200Medicaid
SD5700560Medicaid
050018912Medicare PIN
IA984625Medicaid
SD5700560Medicaid