Provider Demographics
NPI:1841297488
Name:LORDS, DERIC (DPM)
Entity type:Individual
Prefix:DR
First Name:DERIC
Middle Name:
Last Name:LORDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 N KRAEMER BLVD
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3401
Mailing Address - Country:US
Mailing Address - Phone:714-996-7601
Mailing Address - Fax:714-996-0745
Practice Address - Street 1:1310 N KRAEMER BLVD
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3401
Practice Address - Country:US
Practice Address - Phone:714-996-7601
Practice Address - Fax:714-996-0745
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2783213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E2783Medicaid
CA000E2783Medicaid
CAT19233Medicare UPIN
CAE2783Medicare ID - Type Unspecified