Provider Demographics
NPI:1023095833
Name:LOCKWOOD, WILLIAM BYRON (MD, PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BYRON
Last Name:LOCKWOOD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22214
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-0214
Mailing Address - Country:US
Mailing Address - Phone:502-852-1648
Mailing Address - Fax:502-852-2046
Practice Address - Street 1:530 S. JACKSON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-852-6395
Practice Address - Fax:502-852-1761
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18430207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64-006505OtherMEDICAID
H08928Medicare UPIN
KY0285228Medicare ID - Type Unspecified