Provider Demographics
NPI:1922092576
Name:LOCKRIDGE, JASON L (MD)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:L
Last Name:LOCKRIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:900 VILLAGE SQUARE XING STE 290
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1761 PALM BAY RD NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2902
Practice Address - Country:US
Practice Address - Phone:321-220-6400
Practice Address - Fax:321-220-6401
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME140072207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG98774Medicare UPIN