Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 070000787A | IN |
Y | 222Z00000X | Podiatrist | 070000787A | IN |
NPI | 1063457083 |
---|---|
Provider Name | Mr. Jeffery Earl Lovins |
First Address | Greenfield, IN 46140-1404 |
Second Address | Greenfield, IN 46140-1404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 15/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100354660A | (05) | IN |
100418670A | MEDICAID (01) | IN |
U45081 | (02) |