Provider Demographics
NPI:1255537379
Name:LOVELESS, TRINITY MICHELE (MD)
Entity type:Individual
Prefix:
First Name:TRINITY
Middle Name:MICHELE
Last Name:LOVELESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 S MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6719
Mailing Address - Country:US
Mailing Address - Phone:405-265-3900
Mailing Address - Fax:405-265-3905
Practice Address - Street 1:812 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6719
Practice Address - Country:US
Practice Address - Phone:405-265-3900
Practice Address - Fax:405-265-3905
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25703208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200173810AMedicaid