MEDICARE: C LANCE LOVE MDPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	L5028	TX

General Provider Information

NPI Number	:	1346494242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C LANCE LOVE MDPA

Provider Business Mailing Address
First Line	:	820 REUBEN STREET
Second Line	:	SUITE A
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-4436
Country	:	US
Telephone Number	:	830-997-6000
Fax Number	:	830-997-6004

Provider Business Practice Location Address
First Line	:	820 REUBEN STREET
Second Line	:	SUITE A
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-4436
Country	:	US
Telephone Number	:	830-997-6000
Fax Number	:	830-997-6004

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTOPHER LANCE LOVE
Credential	:	MD
Telephone Number	:	830-997-6000

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	12/01/2010

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