Provider Demographics
NPI:1295992089
Name:WATSON LOCKLEAR, MEREDITH BROOKE (MD)
Entity type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:BROOKE
Last Name:WATSON LOCKLEAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEREDITH
Other - Middle Name:BROOKE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1111 W FAIRBANKS AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4720
Mailing Address - Country:US
Mailing Address - Phone:407-635-3024
Mailing Address - Fax:321-203-4626
Practice Address - Street 1:1111 W FAIRBANKS AVE FL 2
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4720
Practice Address - Country:US
Practice Address - Phone:407-635-3024
Practice Address - Fax:321-203-4626
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200800789207V00000X
FLME132738207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909500Medicaid
NC1487COtherBCBS
NC200800789OtherNC LICENSE
NC200800789OtherNC LICENSE