Provider Demographics
NPI:1821082553
Name:LORD, CHRISTINA ALLAINE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ALLAINE
Last Name:LORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4750
Mailing Address - Country:US
Mailing Address - Phone:337-239-1980
Mailing Address - Fax:337-239-1983
Practice Address - Street 1:800 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4750
Practice Address - Country:US
Practice Address - Phone:337-239-1980
Practice Address - Fax:337-239-1983
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2011-08-31
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
LA15446R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1462292Medicaid
LAI18682Medicare UPIN
LA4J103Medicare ID - Type Unspecified