John Lackey, MD

NPI #1063456648 in Pocatello, Idaho

Provider Information

NPI Number: 1063456648
Entity Type: Individual
Name: John Lackey, MD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Credential: MD
Enumeration Date: Jun 15, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 500 S 11TH AVE
City: Pocatello
State: Idaho
ZIP Code: 83201-4835
Phone: (208) 232-3103

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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