Healthcare Provider Details

I. General information

NPI: 1033188123
Provider Name (Legal Business Name): IAN L. LOVE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8038 MESA DR
AUSTIN TX
78731-1319
US

IV. Provider business mailing address

12221 MOPAC EXPRESSWAY NORTH
AUSTIN TX
78758-2483
US

V. Phone/Fax

Practice location:
  • Phone: 512-901-8748
  • Fax: 512-901-8755
Mailing address:
  • Phone: 512-901-8748
  • Fax: 512-901-8755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberJ7559
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: