Provider Demographics
NPI:1336185404
Name:LOVE, LAWRENCE LESLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:LESLE
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 1:1235 NE LOOP 286
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-2226
Mailing Address - Country:US
Mailing Address - Phone:903-785-4166
Mailing Address - Fax:903-785-4172
Practice Address - Street 1:1235 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-2226
Practice Address - Country:US
Practice Address - Phone:903-785-4166
Practice Address - Fax:903-785-4172
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7826207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099476603Medicaid
TX099476603Medicaid
TX8001B8Medicare PIN
TXC18551Medicare UPIN