Provider Demographics
NPI:1982681680
Name:LOVELACE, OSCAR F JR (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:F
Last Name:LOVELACE
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:PO BOX 630
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-0630
Mailing Address - Country:US
Mailing Address - Phone:803-364-4852
Mailing Address - Fax:803-364-2014
Practice Address - Street 1:600 N WHEELER AVE
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127
Practice Address - Country:US
Practice Address - Phone:803-364-4852
Practice Address - Fax:803-364-2014
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14022207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080054869OtherRAILROAD MEDICARE
SCTL4215Medicaid
SC1408217OtherCIGNA
SC1408217OtherCIGNA
SCTL4215Medicaid