Provider Demographics
NPI:1134314511
Name:LOYO-MOLINA, JOSE GREGORIO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:GREGORIO
Last Name:LOYO-MOLINA
Suffix:
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 1:2900 MEDICAL CENTER PKWY
Mailing Address - Street 2:SUITE 240A
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3204
Mailing Address - Country:US
Mailing Address - Phone:479-553-2200
Mailing Address - Fax:479-553-2209
Practice Address - Street 1:2900 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 240A
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3204
Practice Address - Country:US
Practice Address - Phone:479-553-2200
Practice Address - Fax:479-553-2909
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ART2007-145207RC0000X
ARE5516207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200120720AMedicaid
AR166408001Medicaid
AR166408001Medicaid