Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 11336 | AZ |
N | 207RA0401X | Internist - Addiction Medicine | MD11336 | AZ |
NPI | 1033247630 |
---|---|
Provider Name | Dr. Michael W. Loes |
First Address | Scottsdale, AZ 85260-4719 |
Second Address | Phoenix, AZ 85029-4816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 17/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
188372200 | OWCP FEDERAL COMPENSATION (01) | AZ |
25492002 | AHCCCS (01) | AZ |
AZ0397010 | BLUE CROSS BLUE SHIELD (01) | AZ |
C99885 | (02) | AZ |