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THEODORE LOCKARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2605 SW WHITE BIRCH DR, ANKENY, IA 50023-7204
(515) 643-7100
(515) 643-7145
Mailing address
PO BOX 1475, DES MOINES, IA 50305-1475
(515) 643-7100
(515) 643-7145

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
24369
IA
207Q00000X
Family Medicine Physician
Primary
MD-24369
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3020271
IA
Enumeration date
08/02/2006
Last updated
01/23/2015
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