Provider Demographics
NPI:1326195124
Name:LOVE, PORCIA BRADFORD (MD)
Entity Type:Individual
Prefix:
First Name:PORCIA
Middle Name:BRADFORD
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 1:4712 BERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3080
Mailing Address - Country:US
Mailing Address - Phone:334-834-3094
Mailing Address - Fax:334-263-0598
Practice Address - Street 1:4712 BERRY BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3080
Practice Address - Country:US
Practice Address - Phone:334-834-3094
Practice Address - Fax:334-263-0598
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.32383207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology