Provider Demographics
NPI:1679741573
Name:TIM R. LOVE, M.D., P.C.
Entity type:Organization
Organization Name:TIM R. LOVE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-751-5683
Mailing Address - Street 1:11101 HEFNER POINTE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5054
Mailing Address - Country:US
Mailing Address - Phone:405-751-5683
Mailing Address - Fax:405-751-9500
Practice Address - Street 1:11101 HEFNER POINTE DR STE 104
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5054
Practice Address - Country:US
Practice Address - Phone:405-751-5683
Practice Address - Fax:405-751-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14771208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK446545991002OtherBCBS
OKOKB5011Medicare PIN