Healthcare Provider Details

I. General information

NPI: 1346349875
Provider Name (Legal Business Name): GARY D LORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST
WARM SPRINGS MT
59756
US

IV. Provider business mailing address

1 MAIN ST
WARM SPRINGS MT
59756
US

V. Phone/Fax

Practice location:
  • Phone: 406-693-1721
  • Fax: 406-693-7069
Mailing address:
  • Phone: 406-693-1721
  • Fax: 406-693-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3977
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: