Provider Demographics
NPI:1336917111
Name:LOCKEN, ERIC
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:LOCKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S BROADWAY STE 3
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6573
Mailing Address - Country:US
Mailing Address - Phone:701-838-1812
Mailing Address - Fax:
Practice Address - Street 1:205 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3934
Practice Address - Country:US
Practice Address - Phone:701-838-1812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist