Healthcare Provider Details

I. General information

NPI: 1255397998
Provider Name (Legal Business Name): BRUCE P LOVETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 LANG AVE NE STE 110
ALBUQUERQUE NM
87109-4475
US

IV. Provider business mailing address

3916 OXBOW VILLAGE LN NW
ALBUQUERQUE NM
87120-1178
US

V. Phone/Fax

Practice location:
  • Phone: 505-264-3310
  • Fax:
Mailing address:
  • Phone: 505-242-6189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number71-172
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: