Healthcare Provider Details

I. General information

NPI: 1790991107
Provider Name (Legal Business Name): RON KENNETH LORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KEN LORD M.D.

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 E RIVERSIDE DRIVE SUITE 201
ST. GEORGE UT
84790
US

IV. Provider business mailing address

PO BOX 911810
ST GEORGE UT
84791-1810
US

V. Phone/Fax

Practice location:
  • Phone: 435-216-7032
  • Fax: 866-836-9639
Mailing address:
  • Phone: 435-216-7032
  • Fax: 866-836-9639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number14350
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number46090
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number8249728-1205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number14237199-1206
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number14350
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number46090
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: