Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 01079883A | IN |
N | 2086S0120X | Pediatric Surgery | 016509 | LA |
N | 2086S0120X | Pediatric Surgery | 62296 | TN |
NPI | 1528024783 |
---|---|
Provider Name | Dr. William A Loe JR. |
First Address | Fort Wayne, IN 46845-1703 |
Second Address | Fort Wayne, IN 46845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 09/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1330035 | (05) | LA |
E64650 | (02) | LA |