Organization
JAY LOCKE MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY E. LOCKE M.D. (MEDICAL DIRECTOR)
(937) 689-5169
Entity
Organization
Contact information
Practice address
2224 S 77 SUNSHINE STRIP, SUITE 96 BOX 193, HARLINGEN, TX 78550-8305
(937) 689-5169
Mailing address
2224 S 77 SUNSHINE STRIP, SUITE 96 BOX 193, HARLINGEN, TX 78550-8305
(937) 689-5169
(888) 491-9511
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
35085207
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000353030
ANTHEM
—
01
—
201572741
TRICARE
—
01
—
201572741027
CARESOURCE
—
05
—
2250942
—
OH
01
—
P00201720
RR MEDICARE
—
Enumeration date
08/31/2006
Last updated
11/08/2014
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