Provider Demographics
NPI:1548427032
Name:DR ALONZO E LOCKHART MD PC
Entity Type:Organization
Organization Name:DR ALONZO E LOCKHART MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALONZO
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-547-6543
Mailing Address - Street 1:1329 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-6310
Mailing Address - Country:US
Mailing Address - Phone:714-547-6542
Mailing Address - Fax:714-547-6597
Practice Address - Street 1:1329 E 1ST ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-6310
Practice Address - Country:US
Practice Address - Phone:714-547-6542
Practice Address - Fax:714-547-6597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty