=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891918140
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN FLETCHER LOVEJOY JR. MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4901 RICHARD STREET SPECIALTY HOSPITAL
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32207-7328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-730-5755
-----------------------------------------------------
Fax | 904-730-5991
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6408 SAN JOSE BLVD WEST
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-608-0055
-----------------------------------------------------
Fax | 904-730-5991
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | ME0012984
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------