Provider Demographics
NPI:1720137268
Name:ROBERTSON, LILLIAN LOCKETT (MD)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:LOCKETT
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LILLIAN
Other - Middle Name:DORIS
Other - Last Name:LOCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3534 ELMRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-4112
Mailing Address - Country:US
Mailing Address - Phone:979-292-5012
Mailing Address - Fax:713-668-0469
Practice Address - Street 1:1717 S J ST
Practice Address - Street 2:MS 01-38
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4933
Practice Address - Country:US
Practice Address - Phone:979-292-5012
Practice Address - Fax:713-668-0469
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1463207V00000X
WAMD 60435457207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034120801Medicaid
TXF36663Medicare UPIN
TX00J94KMedicare ID - Type Unspecified