Healthcare Provider Details

I. General information

NPI: 1679741573
Provider Name (Legal Business Name): TIM R. LOVE, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2008
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: TIM R. LOVE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 405-751-5683