Individual provider · Type 1 NPI

John Lackey, MD

Specialist · Pocatello, ID

NPI number 1063456648 Active

Practice location

500 S 11th Ave
Pocatello, ID 83201-4835

Call (208) 232-3103 Map

Fax (208) 232-0756

Mailing address

700 Canyon Dr
Pocatello, ID 83204-4840

Specialties and licenses

TaxonomyCodeLicense
Specialist Primary 174400000XM3873 (ID)

Specialist: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

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About NPI 1063456648

John Lackey, MD's National Provider Identifier is 1063456648, issued on Jun 15, 2006. The primary taxonomy on file is Specialist (174400000X), and the practice location is in Pocatello, ID. The record was last updated on Jul 8, 2007.