Provider Demographics
NPI:1922090356
Name:LORE, STEVE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:LORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:C
Other - Last Name:LORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PLLC
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 1:762 14TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3413
Practice Address - Country:US
Practice Address - Phone:775-738-5850
Practice Address - Fax:775-753-7190
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5356508-1205207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8054737Medicaid
UTI16643Medicare UPIN
ID8054737Medicaid
UT$$$$$$$$$003Medicaid