=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376817940
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREGORY C. LOVAAS, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/29/2012
-----------------------------------------------------
Last Update Date | 02/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 895 SW 29TH TER
-----------------------------------------------------
City | PALM CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34990-2994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-249-7998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 895 SW 29TH TER
-----------------------------------------------------
City | PALM CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34990-2994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-249-7998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GREGORY C. LOVAAS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 772-249-7998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | ME0040126
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------