Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 35.021219 | OH |
NPI | 1073842910 |
---|---|
Provider Name | Dr. George Walter Loesch |
First Address | Mansfield, OH 44903-1930 |
Second Address | Mansfield, OH 44903-1930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2009 |
Last Update Date | 23/12/2009 |