Provider Demographics
NPI:1770903742
Name:LOCKLEAR, MAURICE KENT (MD)
Entity type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:KENT
Last Name:LOCKLEAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 HALCYON LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9262
Mailing Address - Country:US
Mailing Address - Phone:910-686-3740
Mailing Address - Fax:
Practice Address - Street 1:1605 DOCTORS CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7405
Practice Address - Country:US
Practice Address - Phone:910-343-8736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0096-00110207Q00000X
VA0101044914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine