Provider Demographics
NPI:1982697355
Name:LOCKLEAR, ARBUS E JR (PAC)
Entity Type:Individual
Prefix:
First Name:ARBUS
Middle Name:E
Last Name:LOCKLEAR
Suffix:JR
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-5383
Mailing Address - Country:US
Mailing Address - Phone:910-739-0272
Mailing Address - Fax:910-739-0375
Practice Address - Street 1:309 N ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-5383
Practice Address - Country:US
Practice Address - Phone:910-739-0272
Practice Address - Fax:910-739-0375
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0001-02608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2759964FMedicare ID - Type Unspecified
NCQ02133Medicare UPIN