Healthcare Provider Details

I. General information

NPI: 1659300176
Provider Name (Legal Business Name): JAMES ROLLIN LORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 UNIVERSITY LAKE DR STE 301
ANCHORAGE AK
99508-4658
US

IV. Provider business mailing address

3801 UNIVERSITY LAKE DR STE 301
ANCHORAGE AK
99508-4658
US

V. Phone/Fax

Practice location:
  • Phone: 907-777-1850
  • Fax: 907-561-8891
Mailing address:
  • Phone: 907-777-1850
  • Fax: 907-561-8891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4848
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: