MEDICARE: ELIZABETH LOONEY DI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35.135188	OH
2	207Q00000X	Family Medicine Physician	ME154989	FL

General Provider Information

NPI Number	:	1568824530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH LOONEY DI MD

Provider Business Mailing Address
First Line	:	400 HEALTH PARK BLVD
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-5784
Country	:	US
Telephone Number	:	904-819-1006
Fax Number	:	904-819-1008

Provider Business Practice Location Address
First Line	:	304 ASHOURIAN AVE STE 105
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-5110
Country	:	US
Telephone Number	:	904-819-1006
Fax Number	:	904-819-1008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2016
Last Update Date	:	05/10/2025

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