Healthcare Provider Details

I. General information

NPI: 1518030808
Provider Name (Legal Business Name): TED R. LOYD SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 BUFFALO DR.
ALPINE WY
83128-3109
US

IV. Provider business mailing address

PO BOX 1287
JACKSON WY
83001-1287
US

V. Phone/Fax

Practice location:
  • Phone: 307-883-4569
  • Fax: 307-883-4568
Mailing address:
  • Phone: 307-883-4569
  • Fax: 307-883-4568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: