Individual
MR. FRED A. LORD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
745 OLIVE ST, SUITE 100, SHREVEPORT, LA 71104-2246
(318) 227-1163
(318) 227-0413
Mailing address
243 SCARLETT PVT DR, GLOSTER, LA 71030
(318) 925-5826
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
033348
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1399370
—
LA
Enumeration date
04/24/2007
Last updated
07/08/2007
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