Provider Demographics
NPI:1366497844
Name:LOVETT, CRAIG H (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:H
Last Name:LOVETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:ALTAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95221-0610
Mailing Address - Country:US
Mailing Address - Phone:209-736-2030
Mailing Address - Fax:209-736-9312
Practice Address - Street 1:585 STANISLAUS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ALTAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95221
Practice Address - Country:US
Practice Address - Phone:209-736-2030
Practice Address - Fax:209-736-9312
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G547540207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G547540Medicaid
CAZZZ31448ZMedicare ID - Type UnspecifiedMEDICARE GROUP ID
CA00G547541Medicare ID - Type UnspecifiedSECONDARY OFFICE LOCATION
CA00G547540Medicaid
CA00G547540Medicare ID - Type UnspecifiedPRIMARY LOCATION ID