Healthcare Provider Details

I. General information

NPI: 1467648170
Provider Name (Legal Business Name): RIVERGATE DERMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BLUEBIRD DR
GOODLETTSVILLE TN
37072-2301
US

IV. Provider business mailing address

201 BLUEBIRD DR
GOODLETTSVILLE TN
37072-2301
US

V. Phone/Fax

Practice location:
  • Phone: 615-859-7546
  • Fax: 615-851-7760
Mailing address:
  • Phone: 615-859-7546
  • Fax: 615-851-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMDO17949
License Number StateTN

VIII. Authorized Official

Name: DR. KEITH H. LOVEN
Title or Position: OWNER/LEAD DOCTOR
Credential:
Phone: 615-859-7546