MEDICARE: DR. ELWOOD L LOVERIDGE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247ZC0005X	Clinical Laboratory Director (Non-physician)

General Provider Information

NPI Number	:	1154798593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELWOOD L LOVERIDGE PHD

Provider Business Mailing Address
First Line	:	150 E 700 S
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84111-3806
Country	:	US
Telephone Number	:	801-364-8080
Fax Number	:	801-521-5969

Provider Business Practice Location Address
First Line	:	150 E 700 S
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84111-3806
Country	:	US
Telephone Number	:	801-364-8080
Fax Number	:	801-521-5969

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2015
Last Update Date	:	09/01/2015

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Directions to “ DR. ELWOOD L LOVERIDGE PHD” Practice Location

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