Provider Demographics
NPI:1750342770
Name:LOCKE, THOMAS HENRY (MD MPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:HENRY
Last Name:LOCKE
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E 4TH ST
Mailing Address - Street 2:STE 14
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3015
Mailing Address - Country:US
Mailing Address - Phone:360-417-2437
Mailing Address - Fax:360-417-2583
Practice Address - Street 1:223 E 4TH ST
Practice Address - Street 2:STE 14
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3015
Practice Address - Country:US
Practice Address - Phone:360-417-2437
Practice Address - Fax:360-417-2583
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000171432083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1521400Medicaid
A07991Medicare UPIN
000500348Medicare ID - Type Unspecified
WA1521400Medicaid