Provider Demographics
NPI:1033238597
Name:LOVE, JOANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 DANIELS ST
Mailing Address - Street 2:
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901-3319
Mailing Address - Country:US
Mailing Address - Phone:575-740-0427
Mailing Address - Fax:575-894-0777
Practice Address - Street 1:565 DANIELS ST
Practice Address - Street 2:
Practice Address - City:T OR C
Practice Address - State:NM
Practice Address - Zip Code:87901-3319
Practice Address - Country:US
Practice Address - Phone:575-740-0427
Practice Address - Fax:575-894-0777
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM200504682083X0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01786342Medicaid
NM46650024Medicaid
NM73805858Medicaid
NM28777841Medicaid
NM51305879Medicaid
NM53938577Medicaid
NM51305879Medicaid
NM53938577Medicaid