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General NPI Number Information
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NPI Number | 1528024783
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Entity Type | Individual
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Provider Name | WILLIAM A LOE JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 11123 PARKVIEW PLAZA DR STE 200
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City | FORT WAYNE
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State | IN
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Zip | 46845
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Country | US
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Telephone | 260-425-6100
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Fax | 260-425-6105
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Provider Business Mailing Address
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Address Line | 3702 NEW VISION DR BLDG B
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City | FORT WAYNE
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State | IN
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Zip | 46845-1703
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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 | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 016509
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 52366
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 62296
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 01079883A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | ME111827
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License Number State | FL
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