MEDICARE: BRUCE P LOVETT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	71-172	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255397998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE P LOVETT MD

Provider Business Mailing Address
First Line	:	3916 OXBOW VILLAGE LN NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-1178
Country	:	US
Telephone Number	:	505-242-6189
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 LANG AVE NE STE 110
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4475
Country	:	US
Telephone Number	:	505-264-3310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	10/06/2011

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Directions to “ BRUCE P LOVETT MD” Practice Location

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