Healthcare Provider Details

I. General information

NPI: 1336142447
Provider Name (Legal Business Name): THOMAS MARION LOEB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 DUTCHMANS LN SUITE 310
LOUISVILLE KY
40207-4702
US

IV. Provider business mailing address

100 E LIBERTY ST SUITE 800
LOUISVILLE KY
40202-1434
US

V. Phone/Fax

Practice location:
  • Phone: 502-253-4120
  • Fax: 502-253-4121
Mailing address:
  • Phone: 502-253-4120
  • Fax: 502-253-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number16798
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number16798
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: