Healthcare Provider Details

I. General information

NPI: 1346263514
Provider Name (Legal Business Name): LAVERNE RAY LOVELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 HUMPHREYS BLVD
MEMPHIS TN
38120-2300
US

IV. Provider business mailing address

6325 HUMPHREYS BLVD
MEMPHIS TN
38120-2300
US

V. Phone/Fax

Practice location:
  • Phone: 901-522-2600
  • Fax: 901-260-0555
Mailing address:
  • Phone: 901-522-7700
  • Fax: 901-260-0555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number31929
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: