Basic Information
| Provider Information | |||||||||
| NPI: | 1003002742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOCKMAN | ||||||||
| FirstName: | BRETT | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18575 LAMBERT LAKE RD | ||||||||
| Address2: | |||||||||
| City: | SONORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953709333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147667817 | ||||||||
| FaxNumber: | 8333020274 | ||||||||
| Practice Location | |||||||||
| Address1: | 19468 VILLAGE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | SONORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953709228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095364776 | ||||||||
| FaxNumber: | 8333020274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2007 | ||||||||
| LastUpdateDate: | 08/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | N0221 | TX | N | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | 204D00000X | 2015158 | CA | N | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | 208100000X | N0221 | TX | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 2015158 | CA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2081P0301X | 20A15158 | CA | N | 2081P2900X | 4156 | IA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 2081S0010X | N0221 | TX | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | 2081S0010X | 4156 | IA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | 2081S0010X | 20A15158 | CA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | 208VP0000X | 4156 | IA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | 4156 | IA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208VP0014X | 20A15158 | CA | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00784683 | 01 | NC | RAILROAD MEDICARE | OTHER | 2915767 | 01 | NC | UHC | OTHER | 1542X | 01 | NC | BCBSNC | OTHER | 0009606357 | 01 | NC | AETNA | OTHER | 2235045 | 01 | NC | MAMSI | OTHER |