Provider Demographics
NPI:1831196450
Name:LOCKLEAR, GREGORY (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
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 1:1011 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3328
Mailing Address - Country:US
Mailing Address - Phone:910-739-8825
Mailing Address - Fax:910-739-8823
Practice Address - Street 1:1011 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3328
Practice Address - Country:US
Practice Address - Phone:910-739-8825
Practice Address - Fax:910-739-8823
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29856207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8952432Medicaid
NC8952432Medicaid
203649CMedicare PIN