Provider Demographics
NPI:1326174095
Name:STEVEN C. LORE, M.D., P.L.L.C.
Entity Type:Organization
Organization Name:STEVEN C. LORE, M.D., P.L.L.C.
Other - Org Name:LORE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:LORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-698-9213
Mailing Address - Street 1:PO BOX 1155
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-5155
Mailing Address - Country:US
Mailing Address - Phone:801-698-9213
Mailing Address - Fax:801-296-2316
Practice Address - Street 1:1439 N 400 W
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-1127
Practice Address - Country:US
Practice Address - Phone:801-698-9213
Practice Address - Fax:801-296-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5356508-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000060383Medicare PIN