Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 25556 | IA |
NPI | 1043312432 |
---|---|
Provider Name | Charles W Love |
First Address | West Des Moines, IA 50266-8294 |
Second Address | West Des Moines, IA 50266-8294 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 24/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0055657 | (05) | IA |
070011310 | RAILROAD MEDICARE (01) | IA |
2972 | MIDLANDS (01) | IA |
D89661 | (02) |