Healthcare Provider Details

I. General information

NPI: 1063488617
Provider Name (Legal Business Name): PAUL LOAR III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W 38TH ST SUITE 300
AUSTIN TX
78705-1163
US

IV. Provider business mailing address

PO BOX 911230
DALLAS TX
75391-1230
US

V. Phone/Fax

Practice location:
  • Phone: 512-421-4100
  • Fax: 512-453-1226
Mailing address:
  • Phone: 972-997-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME93500
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberN2629
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberN2629
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: