Provider Demographics
NPI:1255397998
Name:LOVETT, BRUCE P (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:P
Last Name:LOVETT
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 1:3916 OXBOW VILLAGE LN NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1178
Mailing Address - Country:US
Mailing Address - Phone:505-242-6189
Mailing Address - Fax:
Practice Address - Street 1:4801 LANG AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4475
Practice Address - Country:US
Practice Address - Phone:505-264-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM71-1722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM22293Medicaid
NM22293Medicaid
NME74964Medicare UPIN