Healthcare Provider Details

I. General information

NPI: 1366565095
Provider Name (Legal Business Name): ROBERT G LOVELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBERT LOVELL

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 S OREM BLVD
OREM UT
84058-5011
US

IV. Provider business mailing address

PO BOX 1442
PROVO UT
84603-1442
US

V. Phone/Fax

Practice location:
  • Phone: 801-225-5407
  • Fax: 801-225-5623
Mailing address:
  • Phone: 801-225-5407
  • Fax: 801-225-5623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number1558861205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number1558861205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number1558861205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number1558861205
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number1558861205
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number1558861205
License Number StateUT
# 7
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number1558861205
License Number StateUT
# 8
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number1558861205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: