Individual
EVAN ROBERT LOCKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2050A 2ND ST SE, KIRTLAND AFB, NM 87117-1809
(505) 846-3200
Mailing address
18324 MAFFEY DR, CASTRO VALLEY, CA 94546-2267
(510) 363-0041
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35188
NE
208D00000X
General Practice Physician
35188
NE
Other
Enumeration date
03/07/2021
Last updated
07/18/2024
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