Provider Demographics
NPI:1568460954
Name:LORD, BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:LORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77251-1400
Mailing Address - Country:US
Mailing Address - Phone:713-351-0630
Mailing Address - Fax:713-351-0636
Practice Address - Street 1:1140 WESTMONT DR
Practice Address - Street 2:SUITE 425
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-4363
Practice Address - Country:US
Practice Address - Phone:713-453-4395
Practice Address - Fax:713-453-4397
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5390208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034568802Medicaid
TXB34539Medicare UPIN
TX034568802Medicaid