Provider Demographics
NPI:1730147018
Name:PAUL, LOVE D (MD)
Entity type:Individual
Prefix:
First Name:LOVE
Middle Name:D
Last Name:PAUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 270075
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-0075
Mailing Address - Country:US
Mailing Address - Phone:512-837-6000
Mailing Address - Fax:512-837-6001
Practice Address - Street 1:12201 RENFERT WAY
Practice Address - Street 2:SUITE 315
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5354
Practice Address - Country:US
Practice Address - Phone:512-837-6000
Practice Address - Fax:512-837-6001
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89M32601OtherBCBS
TXP089M3266Medicaid
TX4314141OtherAETNA
TX89M326Medicare ID - Type Unspecified
TXP089M3266Medicaid