Provider Demographics
NPI:1316970387
Name:CRAIG H. LOVETT, M.D., INC
Entity type:Organization
Organization Name:CRAIG H. LOVETT, M.D., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOVETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-736-2030
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:ALTAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95221-0610
Mailing Address - Country:US
Mailing Address - Phone:209-736-2030
Mailing Address - Fax:209-736-9312
Practice Address - Street 1:585 STANISLAUS
Practice Address - Street 2:SUITE A
Practice Address - City:ALTAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95221
Practice Address - Country:US
Practice Address - Phone:209-736-2030
Practice Address - Fax:209-736-9312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG547540207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA200004190OtherRR MEDICARE
CAZZZ31448ZMedicare PIN
CA00G547540Medicare PIN
CA1021900001Medicare NSC