Healthcare Provider Details

I. General information

NPI: 1205037504
Provider Name (Legal Business Name): FRANK KING LORD III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 FAIRVIEW ST
SILVERTON OR
97381-1917
US

IV. Provider business mailing address

342 FAIRVIEW ST
SILVERTON OR
97381-1917
US

V. Phone/Fax

Practice location:
  • Phone: 503-873-1690
  • Fax: 503-873-1656
Mailing address:
  • Phone: 503-873-1690
  • Fax: 503-873-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberMD09064
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: