Provider Demographics
NPI:1376817940
Name:GREGORY C. LOVAAS, MD, PA
Entity Type:Organization
Organization Name:GREGORY C. LOVAAS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOVAAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-249-7998
Mailing Address - Street 1:895 SW 29TH TER
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2994
Mailing Address - Country:US
Mailing Address - Phone:772-249-7998
Mailing Address - Fax:
Practice Address - Street 1:895 SW 29TH TER
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2994
Practice Address - Country:US
Practice Address - Phone:772-249-7998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040126208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty