Provider Demographics
NPI:1790991107
Name:LORD, RON KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:KENNETH
Last Name:LORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KEN
Other - Middle Name:
Other - Last Name:LORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 911810
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-1810
Mailing Address - Country:US
Mailing Address - Phone:435-216-7032
Mailing Address - Fax:866-836-9639
Practice Address - Street 1:585 E RIVERSIDE DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-216-7032
Practice Address - Fax:866-836-9639
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46090207W00000X
NV14350207W00000X
UT8249728-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ154615Medicare PIN
NVGG486AMedicare PIN
UTU000076080Medicare UPIN