Provider Demographics
NPI:1366532442
Name:LOVICH, STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:LOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 S PACIFIC HWY
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-6649
Mailing Address - Country:US
Mailing Address - Phone:541-512-4771
Mailing Address - Fax:541-512-0880
Practice Address - Street 1:280 S PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540-6649
Practice Address - Country:US
Practice Address - Phone:541-512-4771
Practice Address - Fax:541-512-0880
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24794208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR232889Medicaid
OR232889Medicaid
ORR118030Medicare ID - Type Unspecified