Provider Demographics
NPI:1992087837
Name:LORD, DAVID (CSA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LORD
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5223 RISING COMET LN
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-5926
Mailing Address - Country:US
Mailing Address - Phone:561-346-2228
Mailing Address - Fax:
Practice Address - Street 1:5223 RISING COMET LN
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-5926
Practice Address - Country:US
Practice Address - Phone:561-346-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL515573146L00000X
FL3691246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic