Provider Demographics
NPI:1548226277
Name:LOVATO, ALFRED A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:A
Last Name:LOVATO
Suffix:JR
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 1:5700 SAN ANTONIO DR NE
Mailing Address - Street 2:STE B4
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4179
Mailing Address - Country:US
Mailing Address - Phone:505-247-1073
Mailing Address - Fax:505-247-2153
Practice Address - Street 1:4333 PAN AMERICAN FWY NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6831
Practice Address - Country:US
Practice Address - Phone:505-247-1073
Practice Address - Fax:505-247-2153
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM86-271207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMF8265Medicaid
NML1409Medicaid
NML1409Medicaid