Provider Demographics
NPI:1215975339
Name:LYFORD, GREGORY LLOYD (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:LLOYD
Last Name:LYFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 W PEBBLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2634 W PEBBLE CREEK DR
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8908
Practice Address - Country:US
Practice Address - Phone:417-725-4983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004007608207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209011600Medicaid
189228OtherBLUE CROSS BLUE SHIELD
917924838Medicare ID - Type Unspecified
189228OtherBLUE CROSS BLUE SHIELD