Provider Demographics
NPI:1902185077
Name:LOVELL, ANDREW JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOSEPH
Last Name:LOVELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2835
Mailing Address - Country:US
Mailing Address - Phone:214-423-4141
Mailing Address - Fax:
Practice Address - Street 1:3848 N TARRANT PKWY STE 160
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5425
Practice Address - Country:US
Practice Address - Phone:817-482-9831
Practice Address - Fax:682-990-6222
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5672207Q00000X
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program