Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

John Lackey, MD

Individual provider Specialist · NPI 1063456648

John Lackey, MD is an Obstetrics/Gynecology in Pocatello, Idaho. Graduated from University of Missouri, Columbia School of Medicine in 1968, 58 years ago. Practices with Shoshone Bannock Tribes, Inc, a 2-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Idaho.

Years since qualifying
58
Trained at
University of Missouri, Columbia School of Medicine
Licensed in
ID
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

500 S 11th Ave
Pocatello, ID 83201-4835
Phone: (208) 232-3103
Fax: (208) 232-0756
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence M3873 (ID)

Record details

NPI number1063456648
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 15, 2006
Last updated in NPPESJuly 8, 2007
Mailing address700 Canyon Dr, Pocatello, ID 83204-4840

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOBSTETRICS/GYNECOLOGY
Also practisesGENERAL PRACTICE
Medical schoolUNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE
Graduated 1968 (58 years in practice)
Group practice Shoshone Bannock Tribes, Inc — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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