Lovelace, Glen S

Lovelace, Glen S is an sole proprietor health care provider with primary practice located at 333 N 1St St Ste 260 , Boise ID 83702-6132. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics, which is considered as his primary health care specialty. Lovelace, Glen S can be contacted via phone (208) 345-3136.

Contact Information

Primary practice address
333 N 1St St Ste 260 Boise ID 83702-6132
Phone: (208) 345-3136
Fax: (208) 345-0984
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics 207VX0000X M6570 Idaho

Profile Details

NPI number 1720023930
LBN Legal business name Lovelace, Glen S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 19th, 2006
Last updated Aug 23rd, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720023930 NPPES
Idaho Other 000010002170 BLUE SHIELD
Idaho MEDICAID 003795800 BLUE SHIELD
Idaho Other 37382 BLUE SHIELD

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