Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 7960A | WY |
Y | 111NI0900X | Internist | 7960A | WY |
NPI | 1003066838 |
---|---|
Provider Name | Jason Dee Lovell |
First Address | Casper, WY 82601-2818 |
Second Address | Casper, WY 82601-2818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2008 |
Last Update Date | 14/02/2017 |