Provider Demographics
NPI:1144327701
Name:LOVE, WALLACE BOND (MD)
Entity type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:BOND
Last Name:LOVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2119 E 31ST PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2207
Mailing Address - Country:US
Mailing Address - Phone:918-747-5770
Mailing Address - Fax:918-747-5770
Practice Address - Street 1:9322 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-3721
Practice Address - Country:US
Practice Address - Phone:918-764-7232
Practice Address - Fax:918-764-7257
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK9432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine