Provider Demographics
NPI:1356588222
Name:LOVELESS, GERALD CURL LEE (BS)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:CURL LEE
Last Name:LOVELESS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:MR
Other - First Name:GERALD
Other - Middle Name:LEE
Other - Last Name:CLEVENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:2030 SE SALMON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3842
Mailing Address - Country:US
Mailing Address - Phone:503-515-2984
Mailing Address - Fax:503-252-7763
Practice Address - Street 1:1500 NE IRVING ST
Practice Address - Street 2:SUITE 250
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2243
Practice Address - Country:US
Practice Address - Phone:503-233-4356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator