Healthcare Provider Details

I. General information

NPI: 1215975339
Provider Name (Legal Business Name): GREGORY LLOYD LYFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2634 W PEBBLE CREEK DR
NIXA MO
65714-8908
US

IV. Provider business mailing address

2634 W PEBBLE CREEK DR
NIXA MO
65714-8908
US

V. Phone/Fax

Practice location:
  • Phone: 417-725-4983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2004007608
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: