Provider Demographics
NPI:1558328633
Name:LOVINGGOOD, JAMES PERRY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PERRY
Last Name:LOVINGGOOD
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 1:215 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-7928
Mailing Address - Country:US
Mailing Address - Phone:314-315-9913
Mailing Address - Fax:314-355-6881
Practice Address - Street 1:215 DUNN RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031
Practice Address - Country:US
Practice Address - Phone:314-315-9917
Practice Address - Fax:314-355-6881
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.076852208800000X
MOR4D58208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202471207Medicaid
MOP00195681OtherPALMETTO RR MEDICARE
MOP00195681OtherPALMETTO RR MEDICARE
MO002014400Medicare ID - Type Unspecified