Provider Demographics
NPI:1093988099
Name:J. MYRON LORD, M.D.,INC.
Entity Type:Organization
Organization Name:J. MYRON LORD, M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J.
Authorized Official - Middle Name:MYRON
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-781-3561
Mailing Address - Street 1:229 W CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3401
Mailing Address - Country:US
Mailing Address - Phone:559-781-3561
Mailing Address - Fax:559-781-9367
Practice Address - Street 1:229 W CHERRY AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3401
Practice Address - Country:US
Practice Address - Phone:559-781-3561
Practice Address - Fax:559-781-9367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28520207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C285200Medicaid
CA00C285200Medicaid
CA00C285200Medicare PIN