MEDICARE: ROYCE E LOVERN D.O.

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	R5B95	MO

General Provider Information

NPI Number	:	1710940713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROYCE E LOVERN D.O.

Provider Business Mailing Address
First Line	:	128 HICKORY LN
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-1222
Country	:	US
Telephone Number	:	314-307-1968
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 HICKORY LN
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-1222
Country	:	US
Telephone Number	:	314-307-1968
Fax Number	:

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/26/2013

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Directions to “ ROYCE E LOVERN D.O.” Practice Location

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