=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093988099
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J. MYRON LORD, M.D.,INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2008
-----------------------------------------------------
Last Update Date | 04/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 229 W CHERRY AVE
-----------------------------------------------------
City | PORTERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93257-3401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-781-3561
-----------------------------------------------------
Fax | 559-781-9367
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 229 W CHERRY AVE
-----------------------------------------------------
City | PORTERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93257-3401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-781-3561
-----------------------------------------------------
Fax | 559-781-9367
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | J. MYRON LORD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 559-781-3561
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | C28520
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------