Provider Demographics
NPI:1427115153
Name:LOVITT, SPENCER HEATH (CPED)
Entity type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:HEATH
Last Name:LOVITT
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9432 KROETZ DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-4005
Mailing Address - Country:US
Mailing Address - Phone:318-603-9513
Mailing Address - Fax:318-687-0916
Practice Address - Street 1:8837 KINGSTON RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2207
Practice Address - Country:US
Practice Address - Phone:318-687-7317
Practice Address - Fax:318-687-0916
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5379740001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER