Healthcare Provider Details

I. General information

NPI: 1710943204
Provider Name (Legal Business Name): REGINALD OSWALD LORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL LP NE STE 211
ALBUQUERQUE NM
87109-2128
US

IV. Provider business mailing address

101 HOSPITAL LP NE STE 211
ALBUQUERQUE NM
87109-2128
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-1678
  • Fax: 505-888-7684
Mailing address:
  • Phone: 505-888-1678
  • Fax: 505-888-7684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number87263
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: