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Organization
GLEN S LOVELACE MD PA
Active
Organization
GLEN S LOVELACE MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLEN S LOVELACE MD (OWNER)
(208) 345-3136
Entity
Organization
Contact information
Practice address
333 N 1ST ST STE 260, BOISE, ID 83702-6132
(208) 345-3136
(208) 345-0984
Mailing address
333 N 1ST ST STE 260, BOISE, ID 83702-6132
(208) 345-3136
(208) 345-0984
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M6570
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010028711
BLUE SHIELD GROUP NUMBER
ID
01
—
8D608
BLUE CROSS GROUP NUMBER
ID
Enumeration date
06/19/2006
Last updated
06/01/2009
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