Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME79808 | FL |
N | 2080P0204X | Pediatric Emergency Doctor | ME79808 | FL |
NPI | 1144266099 |
---|---|
Provider Name | Dr. Thomas G. Mc Loughlin JR. |
First Address | Ormond Beach, FL 32174-5715 |
Second Address | Ormond Beach, FL 32174-5715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 02/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
258515400 | (05) | FL |
49725 | BLUE SHIELD OF FL (01) | FL |
H13917 | (02) |