Individual
MR. CHARLES J LORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
419 QUINCY STREET, RAPID CITY, SD 57701
(605) 348-6365
(605) 348-9408
Mailing address
419 QUINCY STREET, RAPID CITY, SD 57701
(605) 348-6365
(605) 348-9408
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2247
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100080
—
SD
Enumeration date
11/20/2006
Last updated
01/21/2010
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