Evan Robert Locke, MD
Individual provider Active NPI Family Medicine Physician · Kirtland Afb, NM
NPI 1215522685 · NPPES record last updated Jul 18, 2024
Key facts
- NPI
- 1215522685
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 35188 (NE)
- Practice address
- 2050A 2ND St SE
Kirtland Afb, NM 87117-1809 - Phone
- (505) 846-3200
- NPI assigned
- Mar 7, 2021
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230103001396 | CA | Order and Referring Only - Family Practice |
0840660163 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35188 | NE | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wea Ca PC | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35188 | NE | Yes |
| General Practice Physician | 208D00000X | 35188 | NE |
Addresses
Primary practice location
2050A 2ND St SE
Kirtland Afb, NM 87117-1809
Mailing address
18324 Maffey Dr
Castro Valley, CA 94546-2267
Phone (510) 363-0041
Other providers in Kirtland Afb, NM
- Kathryn M Kovanen
- Matthew Joseph Lang
- Jessica Rose Laurino
- Michael Lavin
- Robert Lewis
- Robert Joseph Love
- Thomas D. Fadell Luna
- Lauren Maccoy
- Shannon Maclean
- Scott Richard Marrs
All providers in Kirtland Afb, NM · Family Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.