Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D.6854-C1 | AL |
NPI | 1114379609 |
---|---|
Provider Name | Dr. Matthew Loeb |
First Address | Tuscaloosa, AL 35404-2983 |
Second Address | Tuscaloosa, AL 35404-2983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2016 |
Last Update Date | 21/06/2021 |