Provider Demographics
NPI:1669405593
Name:LOCKARD, THOMAS EDWARD (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:LOCKARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 MURRAY DR SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-5346
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2422 DANVILLE RD SW
Practice Address - Street 2:SUITE E
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4220
Practice Address - Country:US
Practice Address - Phone:256-355-9040
Practice Address - Fax:256-355-9040
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF84062Medicare UPIN
AL051554491Medicare ID - Type Unspecified