=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801818836
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN K. LOVELL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2006
-----------------------------------------------------
Last Update Date | 11/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2430 W HORIZON RIDGE PKWY ATTN. J. KREED LOVELL, MD
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-2729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-247-9994
-----------------------------------------------------
Fax | 702-651-9995
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2430 W HORIZON RIDGE PKWY ATTN. J. KREED LOVELL, MD
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-247-9994
-----------------------------------------------------
Fax | 702-651-9995
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 5084
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0600X
-----------------------------------------------------
Taxonomy Name | Clinical Neurophysiology Physician
-----------------------------------------------------
License Number | 5084
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------