Healthcare Provider Details

I. General information

NPI: 1801647458
Provider Name (Legal Business Name): RYAN M LOVE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 03/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 E 19TH ST STE 703
TULSA OK
74104-5418
US

IV. Provider business mailing address

1705 E 19TH ST STE 703
TULSA OK
74104-5418
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTBD
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: