Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | ME46760 | FL |
NPI | 1184150625 |
---|---|
Provider Name | Pamela Loftus |
First Address | Boca Raton, FL 33434-5310 |
Second Address | Boca Raton, FL 33434-5310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2017 |
Last Update Date | 03/05/2017 |