Healthcare Provider Details

I. General information

NPI: 1043234032
Provider Name (Legal Business Name): TIM RODNEY LOVE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 HEFNER POINTE DR STE 104
OKLAHOMA CITY OK
73120-5054
US

IV. Provider business mailing address

11101 HEFNER POINTE DR STE 104
OKLAHOMA CITY OK
73120-5054
US

V. Phone/Fax

Practice location:
  • Phone: 405-751-5683
  • Fax: 405-751-9500
Mailing address:
  • Phone: 405-751-5683
  • Fax: 405-751-9500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number14771
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: