Healthcare Provider Details

I. General information

NPI: 1821082553
Provider Name (Legal Business Name): CHRISTINA ALLAINE LORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date: 03/25/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

800 S 3RD ST
LEESVILLE LA
71446-4750
US

IV. Provider business mailing address

800 S 3RD ST
LEESVILLE LA
71446-4750
US

V. Phone/Fax

Practice location:
  • Phone: 337-239-1980
  • Fax: 337-239-1983
Mailing address:
  • Phone: 337-239-1980
  • Fax: 337-239-1983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number15446R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: