Healthcare Provider Details

I. General information

NPI: 1679504476
Provider Name (Legal Business Name): MICHAEL HOGIN LOVELACE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2169 S LAMAR BLVD
OXFORD MS
38655-5223
US

IV. Provider business mailing address

2169 S LAMAR BLVD
OXFORD MS
38655-5223
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-1530
  • Fax: 662-236-0028
Mailing address:
  • Phone: 662-234-1530
  • Fax: 662-236-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number09150
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number09150
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number09150
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: