Individual
DR. GLEN S LOVELACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
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
207VX0000X
Obstetrics Physician
Primary
M6570
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010002170
BLUE SHIELD
ID
05
—
003795800
—
ID
01
—
37382
BLUE CROSS
ID
Enumeration date
06/19/2006
Last updated
08/23/2017
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