Provider Demographics
NPI:1073628798
Name:LOVE, REBECCA EDWARDS (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:EDWARDS
Last Name:LOVE
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2693 NUEVO CT
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-3501
Mailing Address - Country:US
Mailing Address - Phone:435-260-8640
Mailing Address - Fax:
Practice Address - Street 1:719 W 400 N
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2239
Practice Address - Country:US
Practice Address - Phone:435-259-7191
Practice Address - Fax:435-259-5172
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6092075-1205146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
A63881Medicare UPIN