| Doctor Name: | GREGORY D LORD |
| NPI Number: | 1639162290 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 016350 |
| Business Practice Address: | 301 W Fertitta Blvd Ste 1 Leesville, LA - 714464665 |
| Business Phone Number: | 3372380167 |
| Business Fax Number: | 3372380574 |
| Mailing Address: | 301 W Fertitta Blvd Ste 1, LEESVILLE |
| State: | LA |
| Postal Code: | 714464665 |
| Phone Number: | 3372380167 |
| Fax Number: | 3372380574 |
| NPI Enumeration Date: | 08/29/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 03/23/2006 |
| NPI Reactivation Date: | 04/12/2006 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 016350 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |