Provider Demographics
NPI:1700965662
Name:LOVELL, VICTOR MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:MANUEL
Last Name:LOVELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:415 BURKARTH RD STE D
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-3101
Mailing Address - Country:US
Mailing Address - Phone:660-747-3141
Mailing Address - Fax:660-747-7292
Practice Address - Street 1:415 BURKARTH RD STE D
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-3101
Practice Address - Country:US
Practice Address - Phone:660-747-3141
Practice Address - Fax:660-747-7292
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR8E712080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202115804Medicaid