Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 589 | NC |
N | 222Z00000X | Podiatrist | 589 | NC |
Y | 213EP1101X | Primary Podiatric Medicine | 589 | NC |
NPI | 1497748412 |
---|---|
Provider Name | John Anthony Lord |
First Address | Durham, NC 27704-2150 |
Second Address | Durham, NC 27704-2150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 23/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U95913 | (02) | NC |