Provider Demographics
NPI:1689681355
Name:LOVE, TOMMY LEE JR (MD)
Entity type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:LEE
Last Name:LOVE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 SAINT VINCENT CIR
Mailing Address - Street 2:350
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5405
Mailing Address - Country:US
Mailing Address - Phone:501-664-5932
Mailing Address - Fax:501-664-7301
Practice Address - Street 1:1 SAINT VINCENT CIR
Practice Address - Street 2:350
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5405
Practice Address - Country:US
Practice Address - Phone:501-664-5932
Practice Address - Fax:501-664-7301
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-12-12
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Provider Licenses
StateLicense IDTaxonomies
ARC4841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205895232OtherRAILROAD MEDICARE GA
ARD84232Medicare UPIN
AR5320857220Medicare PIN