Individual
SPENCER CHARLES LOVELACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 N WHEELER AVE, PROSPERITY, SC 29127-9332
(803) 364-4852
Mailing address
PO BOX 630, PROSPERITY, SC 29127-0630
(803) 364-4852
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Q2583
TX
207Q00000X
Family Medicine Physician
Primary
MMD39331
SC
390200000X
Student in an Organized Health Care Education/Training Program
BP10047856
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
393318
—
SC
01
—
575421
BASIC POSTGRADUATE PERMIT
TX
Enumeration date
05/06/2013
Last updated
11/09/2016
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