Provider Demographics
NPI:1003066838
Name:LOVELL, JASON DEE (DO)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DEE
Last Name:LOVELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 S DURBIN ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2818
Mailing Address - Country:US
Mailing Address - Phone:307-337-4284
Mailing Address - Fax:307-462-0922
Practice Address - Street 1:428 S DURBIN ST
Practice Address - Street 2:STE 104
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2818
Practice Address - Country:US
Practice Address - Phone:307-337-4284
Practice Address - Fax:307-462-0922
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7960A207R00000X
WYTL#1032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine