Provider Demographics
NPI:1306061346
Name:LOCKYER, JOHN EDWARD
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:LOCKYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CHISHOLM TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76458-1403
Mailing Address - Country:US
Mailing Address - Phone:940-567-5528
Mailing Address - Fax:940-567-6325
Practice Address - Street 1:215 CHISHOLM TRL
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TX
Practice Address - Zip Code:76458-1403
Practice Address - Country:US
Practice Address - Phone:940-567-5528
Practice Address - Fax:940-567-6325
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX1088213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018629801Medicaid
TX353182Medicare PIN
TX018629801Medicaid