Provider Demographics
NPI:1083662431
Name:LOVE, JEFFREY LEE (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEE
Last Name:LOVE
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 1:1130 22ND ST S STE 1000
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2881
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:205-715-5932
Practice Address - Street 1:110 OXMOOR CT
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-945-0773
Practice Address - Fax:205-945-0426
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39737208D00000X
OH35077061L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64111990Medicaid
KYP00301735OtherRR MEDICARE
KYP00629105OtherRRMCR - NICC
KY000000546223OtherANTHEM - NORTON
KY00533021OtherMEDICARE - NORTON
KY093270OtherSIHO - NORTON
H18044Medicare UPIN
KY64111990Medicaid
KY0609912Medicare PIN
KY00533021OtherMEDICARE - NORTON