Provider Demographics
NPI:1578574729
Name:LOCKE, EDWIN BRADY (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:BRADY
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 1:9 HIALEAH DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-1809
Mailing Address - Country:US
Mailing Address - Phone:432-699-2370
Mailing Address - Fax:432-697-3524
Practice Address - Street 1:2500 WEST ILLINOS
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701
Practice Address - Country:US
Practice Address - Phone:432-699-2370
Practice Address - Fax:432-697-3524
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5608207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128926606Medicaid
TX128926606Medicaid
TXG77718Medicare UPIN