Individual
DR. MIKE L LOCKLEAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 LAFFERTY AVE, CAMERON, TX 76520-2551
(254) 605-1100
(254) 605-1120
Mailing address
101 LAFFERTY AVE, CAMERON, TX 76520-2551
(254) 605-1100
(254) 605-1120
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
F1755
TX
208D00000X
General Practice Physician
Primary
F1755
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
092049801
—
TX
05
—
092049802
—
TX
01
—
118000100
FIRSTCARE
TX
01
—
121567
CHIPS
TX
05
—
130308303
—
TX
01
—
4513443
AETNA
TX
01
—
751839268001
TRICARE/CHAMPUS
TX
01
—
93842
SCOTT & WHITE HEALTH PLAN
TX
Enumeration date
05/05/2006
Last updated
08/29/2013
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