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John Lackey, MD
Specialist in Pocatello, Idaho
NPI 1063456648

John Lackey is a Specialist based in Pocatello, ID. John Lackey practices in Pocatello, ID and has the professional credentials of MD. The NPI Number for John Lackey is 1063456648 and holds a License No. M3873 (Idaho).

The current practice location address for John Lackey is 500 S 11Th Ave, Pocatello, ID and can be reached out via phone at 208-232-3103 and via fax at 208-232-0756.

Location: 500 S 11Th Ave, Pocatello, ID, 83204-4840
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1063456648
Provider Name
John Lackey
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
500 S 11Th Ave, Pocatello, ID, 83204-4840
Phone Number
208-232-3103
Fax Number
208-232-0756
Provider Enumeration Date
06/15/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
002487500 05 ID
institution
Provider Business Practice Location Address Details
Address
500 S 11Th Ave
City
Pocatello
State
Idaho
Zip
83201-4835
Phone Number
208-232-3103
Fax Number
208-232-0756
person
Provider Business Mailing Address Details
Address
500 S 11Th Ave
City
Pocatello
State
Idaho
Zip
83201-4835
Phone Number
208-232-3103
Fax Number
208-232-0756
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
M3873 (Idaho)
Definition
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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