Individual
BRIAN EUGENE LOVELACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4812 S 109TH EAST AVE, SUITE 100, TULSA, OK 74146-5826
(918) 392-1400
(918) 236-4501
Mailing address
4802 S 109TH EAST AVE, TULSA, OK 74146-5822
(918) 392-1400
(918) 392-1488
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
23525
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200196160A
MEDICAID
OK
01
—
OK400474
MEDICARE PTAN
OK
Enumeration date
02/06/2007
Last updated
07/29/2021
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