Provider Demographics
NPI:1578509485
Name:LOCKWOOD, STEPHANIE R (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1300 RIVERSIDE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4353
Mailing Address - Country:US
Mailing Address - Phone:970-224-1670
Mailing Address - Fax:970-495-6218
Practice Address - Street 1:3519 RICHMOND DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5995
Practice Address - Country:US
Practice Address - Phone:970-204-0300
Practice Address - Fax:970-226-9041
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO41182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07071817Medicaid
CO07071817Medicaid