MEDICARE: DR. JERRY WAYNE LOVING .D.O.

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	D8757	TX

General Provider Information

NPI Number	:	1467468801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY WAYNE LOVING .D.O.

Provider Business Mailing Address
First Line	:	8202 LONE STAR RD
Second Line	:
City	:	NORTH ZULCH
State	:	TX
Zip	:	77872-6144
Country	:	US
Telephone Number	:	936-399-4860
Fax Number	:

Provider Business Practice Location Address
First Line	:	8202 LONE STAR RD
Second Line	:
City	:	NORTH ZULCH
State	:	TX
Zip	:	77872-6144
Country	:	US
Telephone Number	:	936-399-4860
Fax Number	:

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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