Healthcare Provider Details

I. General information

NPI: 1003977828
Provider Name (Legal Business Name): LLOYD B LIFTON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 RIVERGATE UNIT 207
DURANGO CO
81301-7490
US

IV. Provider business mailing address

PO BOX 15000
DURANGO CO
81302-8901
US

V. Phone/Fax

Practice location:
  • Phone: 970-259-0701
  • Fax:
Mailing address:
  • Phone: 970-259-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: DR. LLOYD B LIFTON
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 970-259-0701