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General NPI Number Information
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NPI Number | 1629310230
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Entity Type | Organization
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Legal Business Name | TRINITY LOVELESS, MD, PLLC
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Dates
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Enumeration Date | 03/21/2013
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Last Update Date | 03/21/2013
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Provider Practice Location Address
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Address Line | 812 S MUSTANG RD
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City | YUKON
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State | OK
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Zip | 73099-6719
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Country | US
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Telephone | 405-265-3900
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Fax | 405-265-3905
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Provider Business Mailing Address
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Address Line | 812 S MUSTANG RD
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City | YUKON
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State | OK
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Zip | 73099-6719
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Country | US
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Telephone | 405-265-3900
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Fax | 405-265-3905
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | TRINITY MICHELE LOVELESS
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Credential | M.D.
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Telephone | 405-265-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 25703
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License Number State | OK
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