Healthcare Provider Details

I. General information

NPI: 1336303759
Provider Name (Legal Business Name): WALTER X .LOYOLA,M.D.,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 COMMUNICATIONS PKWY SUITE 100
PLANO TX
75093-8449
US

IV. Provider business mailing address

3200 GLENHURST CT
PLANO TX
75093-3448
US

V. Phone/Fax

Practice location:
  • Phone: 972-213-0607
  • Fax:
Mailing address:
  • Phone: 972-312-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WALTER X LOYOLA
Title or Position: OWNER
Credential: M.D.
Phone: 972-312-0607