Healthcare Provider Details

I. General information

NPI: 1528321981
Provider Name (Legal Business Name): TAMMY LOBERG DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 STADIUM DR
SIOUX CITY IA
51106-5157
US

IV. Provider business mailing address

4010 STADIUM DR
SIOUX CITY IA
51106-5157
US

V. Phone/Fax

Practice location:
  • Phone: 712-252-9999
  • Fax: 712-277-4400
Mailing address:
  • Phone: 712-252-9999
  • Fax: 712-277-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number6928
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: