Healthcare Provider Details

I. General information

NPI: 1922090356
Provider Name (Legal Business Name): STEVE LORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STEVEN C. LORE M.D., P.L.L.C.

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

762 14TH ST
ELKO NV
89801-3413
US

IV. Provider business mailing address

PO BOX 1155
CENTERVILLE UT
84014-5155
US

V. Phone/Fax

Practice location:
  • Phone: 775-738-5850
  • Fax: 775-753-7190
Mailing address:
  • Phone: 801-698-9213
  • Fax: 801-296-2316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5356508-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: