Provider Demographics
NPI:1245373794
Name:LOVE, MARK E (PA-C)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:LOVE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1601 E 19TH AVE
Mailing Address - Street 2:SUITE 3550
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1216
Mailing Address - Country:US
Mailing Address - Phone:303-832-2955
Mailing Address - Fax:303-832-2954
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:SUITE 3550
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:303-832-2955
Practice Address - Fax:303-832-2954
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2010-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO136363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
003402OtherKAISER-COMMERCIAL NUMBER