Provider Demographics
NPI:1063530087
Name:LOCKE, SUSAN THOMAS (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:THOMAS
Last Name:LOCKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1524 W LACEY BLVD
Mailing Address - Street 2:SUITE 202B
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5965
Mailing Address - Country:US
Mailing Address - Phone:559-583-4560
Mailing Address - Fax:559-583-4561
Practice Address - Street 1:1524 W LACEY BLVD
Practice Address - Street 2:SUITE 202B
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5965
Practice Address - Country:US
Practice Address - Phone:559-583-4560
Practice Address - Fax:559-583-4561
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA99212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA99212OtherCALIFORNIA LICENSE TO PRA
TNMD46089OtherTN LICENSE
TNMD46089OtherTN LICENSE
CABL8657768OtherDEA REGITRATION