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General NPI Number Information
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NPI Number | 1023645124
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Entity Type | Individual
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Provider Name | JAIME LUIS LOYOLA III MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 3636 HIGH ST
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City | PORTSMOUTH
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State | VA
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Zip | 23707-3236
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Country | US
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Telephone | 757-398-2285
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Fax | 757-397-5368
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Provider Business Mailing Address
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Address Line | 4600 MCAULEY PL STE 600
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City | BLUE ASH
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State | OH
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Zip | 45242-4778
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101278154
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License Number State | VA
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