Healthcare Provider Details

I. General information

NPI: 1457366338
Provider Name (Legal Business Name): MARK LOEBIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 W NEWBERRY RD EMERG DEPT
GAINESVILLE FL
32605-4309
US

IV. Provider business mailing address

PO BOX 409036
ATLANTA GA
30384-9036
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-4900
  • Fax: 904-346-0113
Mailing address:
  • Phone: 888-689-1430
  • Fax: 904-346-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME0039200
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: