Healthcare Provider Details

I. General information

NPI: 1225067085
Provider Name (Legal Business Name): EDWIN J LOEFFEL JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 RUSH DR
SALIDA CO
81201-9627
US

IV. Provider business mailing address

PO BOX 7704
LOVELAND CO
80537-0704
US

V. Phone/Fax

Practice location:
  • Phone: 719-530-8218
  • Fax: 970-667-0847
Mailing address:
  • Phone: 970-663-2742
  • Fax: 970-667-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number19150
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: