Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 20100003513 | MO |
NPI | 1194904755 |
---|---|
Provider Name | Lola J Loeb |
First Address | St. Louis, MO 63112-4265 |
Second Address | St. Louis, MO 63112-4265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2007 |
Last Update Date | 03/03/2010 |