Individual
DR. LESLIE C LOCKRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
639 HOSPITAL DR, MOUNTAIN HOME, AR 72653-2914
(479) 587-1700
(479) 587-1366
Mailing address
3901 PARKWAY CIR, SPRINGDALE, AR 72762-6362
(479) 587-1700
(479) 587-1366
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD10934
RI
207RH0000X
Hematology (Internal Medicine) Physician
Primary
E18889
AR
207RH0003X
Hematology & Oncology Physician
042-0011226
VT
207RH0003X
Hematology & Oncology Physician
0420011226
VT
207RH0003X
Hematology & Oncology Physician
217751
MA
207RH0003X
Hematology & Oncology Physician
MD10934
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013157
—
VT
05
—
9002624
—
RI
Enumeration date
12/05/2005
Last updated
04/01/2025
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