Provider Demographics
NPI:1063488617
Name:LOAR, PAUL III (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:LOAR
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:
Practice Address - Street 1:901 W 38TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1163
Practice Address - Country:US
Practice Address - Phone:512-421-4100
Practice Address - Fax:512-453-1226
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93500207V00000X
TXN2629207VX0201X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204072702Medicaid
TX204072701Medicaid
TX204072703Medicaid
TXP00784608OtherRAILROAD MEDICARE
TX1063488617OtherBCBS TX
TX204072701Medicaid
TX8L17050Medicare PIN
TXP00784608OtherRAILROAD MEDICARE
FLI37880Medicare UPIN