Provider Demographics
NPI:1962413252
Name:LOVELESS, GARY L (CO,LPO,LPED)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:LOVELESS
Suffix:
Gender:M
Credentials:CO,LPO,LPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-1747
Mailing Address - Country:US
Mailing Address - Phone:405-631-9731
Mailing Address - Fax:
Practice Address - Street 1:4400 SW 21ST ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1747
Practice Address - Country:US
Practice Address - Phone:405-631-9731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23332BC3200X
OK31332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0184950001Medicare NSC