Provider Demographics
NPI:1518129121
Name:LOCKE, FREDERICK LUNDRY (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:LUNDRY
Last Name:LOCKE
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 1:12902 USF MAGNOLIA DR
Mailing Address - Street 2:FOB-3
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-9416
Mailing Address - Country:US
Mailing Address - Phone:813-745-3509
Mailing Address - Fax:813-745-8468
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:FOB-3
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:813-745-3509
Practice Address - Fax:813-745-8468
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116059207R00000X
FLME108049207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine