Individual
WALTER JACK LOVERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 RACQUET LN, STE 100, YAKIMA, WA 98902-6114
(509) 249-3900
(509) 573-9539
Mailing address
2500 RACQUET LN, STE 100, YAKIMA, WA 98902-6114
(509) 249-3900
(509) 573-9539
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
025209MD00014720
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015635
—
WA
01
—
340011502
RAILROAD MEDICARE PIN
WA
01
—
340011801
RAILROAD MEDICARE PIN
WA
Enumeration date
09/29/2005
Last updated
11/20/2009
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