Healthcare Provider Details

I. General information

NPI: 1801820493
Provider Name (Legal Business Name): CATHERINE LOE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15502 STONEYBROOK WEST PKWY SUITE 2-108
WINTER GARDEN FL
34787-4767
US

IV. Provider business mailing address

15502 STONEYBROOK WEST PKWY SUITE 2-108
WINTER GARDEN FL
34787-4767
US

V. Phone/Fax

Practice location:
  • Phone: 407-656-0042
  • Fax:
Mailing address:
  • Phone: 407-656-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 113432
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: