Provider Demographics
NPI:1902860703
Name:LOVE, CHRISTOPHER LANCE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LANCE
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 1:820 REUBEN STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4436
Mailing Address - Country:US
Mailing Address - Phone:830-997-6000
Mailing Address - Fax:830-997-6004
Practice Address - Street 1:820 REUBEN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4436
Practice Address - Country:US
Practice Address - Phone:830-997-6000
Practice Address - Fax:830-997-6004
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38499208600000X
TXL5028208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157666202Medicaid
TX8BV380OtherBCBSTX
TX8BV380OtherBCBSTX
TX26-3617075OtherTIN
TX8F10162Medicare PIN