Individual
JACK M LOCKHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3111 GUNDERSEN DR, ONALASKA, WI 54650-8447
(608) 775-8630
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
20752
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31317600
—
WI
Enumeration date
06/23/2005
Last updated
09/26/2011
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