Provider Demographics
NPI:1902057235
Name:LOCKHART, DEWAYNE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DEWAYNE
Middle Name:
Last Name:LOCKHART
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 KRAFT RD SUITE 120
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105
Mailing Address - Country:US
Mailing Address - Phone:239-424-9846
Mailing Address - Fax:239-424-9932
Practice Address - Street 1:3555 KRAFT RD SUITE 120
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105
Practice Address - Country:US
Practice Address - Phone:239-424-9846
Practice Address - Fax:239-424-9932
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116800207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME116800OtherLICENSE NUMBER
FLHN736YMedicare PIN