Individual
DR. JACOB EDWARD LOCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3139 W HOLCOMBE BLVD # 550, HOUSTON, TX 77025-1533
(937) 689-5169
Mailing address
3139 W HOLCOMBE BLVD # 550, HOUSTON, TX 77025-1533
(937) 689-5169
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
35085207
OH
2085R0001X
Radiation Oncology Physician
Primary
N3843
TX
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
07/24/2006
Last updated
11/11/2021
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