Healthcare Provider Details

I. General information

NPI: 1326087800
Provider Name (Legal Business Name): DAVID M LOVELACE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 LINWOOD BLVD
OKLAHOMA CITY OK
73106-5033
US

IV. Provider business mailing address

114 ROLLING WOOD HILLS DR
DURANT OK
74701-1717
US

V. Phone/Fax

Practice location:
  • Phone: 405-706-8808
  • Fax:
Mailing address:
  • Phone: 580-920-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number2710
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2710
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2710
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: