Provider Demographics
NPI:1588649263
Name:LOCKEY FOX LEDFORD & GLAUM MDS PA
Entity Type:Organization
Organization Name:LOCKEY FOX LEDFORD & GLAUM MDS PA
Other - Org Name:ALLERGY, ASTHMA, AND IMMUNOLOGY ASSOCIATES OF TAMPA BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHEARER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:813-971-9743
Mailing Address - Street 1:13801 BRUCE B DOWNS BLVD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3946
Mailing Address - Country:US
Mailing Address - Phone:813-971-9743
Mailing Address - Fax:813-558-9421
Practice Address - Street 1:13801 BRUCE B DOWNS BLVD
Practice Address - Street 2:SUITE 502
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3946
Practice Address - Country:US
Practice Address - Phone:813-971-9743
Practice Address - Fax:813-558-9421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0019662207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34268Medicare ID - Type Unspecified