Healthcare Provider Details

I. General information

NPI: 1447311287
Provider Name (Legal Business Name): LLOYD B LIFTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 11/19/2007
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 Number24321
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: