Provider Demographics
NPI:1811987712
Name:LOVINS, DAWN M (DO)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:LOVINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:LIVINGSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1813 E MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1841
Mailing Address - Country:US
Mailing Address - Phone:918-804-6180
Mailing Address - Fax:918-872-7984
Practice Address - Street 1:111 N BAILEY ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4201
Practice Address - Country:US
Practice Address - Phone:918-824-6324
Practice Address - Fax:918-824-1603
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4208207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200034490AMedicaid
OK244513213Medicare ID - Type Unspecified
I11407Medicare UPIN