Provider Demographics
NPI:1871730325
Name:LOVALL, KEEBLE
Entity type:Individual
Prefix:
First Name:KEEBLE
Middle Name:
Last Name:LOVALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20635 SAPPHIRE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4148
Mailing Address - Country:US
Mailing Address - Phone:281-300-1928
Mailing Address - Fax:
Practice Address - Street 1:20635 SAPPHIRE LAKE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-4148
Practice Address - Country:US
Practice Address - Phone:281-300-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic