Healthcare Provider Details

I. General information

NPI: 1114104197
Provider Name (Legal Business Name): DR. LACEY J LOVELAND DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 06/13/2009
Certification Date:
Deactivation Date: 11/17/2008
Reactivation Date: 05/08/2009

III. Provider practice location address

755 EAST 11TH AVENUE SUITE 200
EUGENE OR
97401-3313
US

IV. Provider business mailing address

755 EAST 11TH AVENUE SUITE 200
EUGENE OR
97401-3313
US

V. Phone/Fax

Practice location:
  • Phone: 541-344-5144
  • Fax: 541-344-5504
Mailing address:
  • Phone: 541-344-5144
  • Fax: 541-344-5504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDP00433
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6148720002
License Number StateOR

VIII. Authorized Official

Name: DR. LACEY J LOVELAND
Title or Position: PRESIDENT
Credential: DPM
Phone: 541-344-5144