Individual
DR. LAYNE T. LOVELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-2000
Mailing address
2026 W GERALD DR, PEORIA, IL 61615-1188
(309) 243-2544
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036062930
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
809840
MEDICARE GROUP #
IL
01
—
809840032
INDIVIDUAL MEDICARE #
IL
05
—
L06674
—
IL
Enumeration date
06/13/2006
Last updated
08/20/2010
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