Healthcare Provider Details

I. General information

NPI: 1851342372
Provider Name (Legal Business Name): RILEY D LOVE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/07/2023
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 LAKEVIEW DR
PADUCAH KY
42001-5619
US

IV. Provider business mailing address

67 LAKEVIEW DR
PADUCAH KY
42001-5619
US

V. Phone/Fax

Practice location:
  • Phone: 270-554-8373
  • Fax: 270-554-8987
Mailing address:
  • Phone: 270-554-8373
  • Fax: 270-554-8987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number26073
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number26073
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: