Provider Demographics
NPI:1689729550
Name:LOVELESS, JAMES WILSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILSON
Last Name:LOVELESS
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 950266
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0266
Mailing Address - Country:US
Mailing Address - Phone:502-896-6355
Mailing Address - Fax:502-896-9813
Practice Address - Street 1:2811 KLEMPNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205
Practice Address - Country:US
Practice Address - Phone:502-896-6355
Practice Address - Fax:502-896-9813
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065487207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00740002OtherMEDICARE RAIL ROAD
KY9881202OtherAETNA
KY1488409OtherMEDICARE
KY0602254OtherCIGNA