Provider Demographics
NPI:1811960255
Name:JACKSON-LOCKYER, MARGO (MD)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:
Last Name:JACKSON-LOCKYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARGO
Other - Middle Name:
Other - Last Name:LAWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:LOCKBOX # 17 2424 E 21ST STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1711
Mailing Address - Country:US
Mailing Address - Phone:866-321-8433
Mailing Address - Fax:
Practice Address - Street 1:300 ROCKEFELLER DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5075
Practice Address - Country:US
Practice Address - Phone:918-781-9466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24750207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148254001Medicaid
OK1811960255OtherBLUE SHIELD
OK200067370AMedicaid
OK200067370AMedicaid
OK1811960255OtherBLUE SHIELD
OKOK400390Medicare PIN