Provider Demographics
NPI:1306828314
Name:LOAIZA, SERGIO (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:
Last Name:LOAIZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:220 FORT SANDERS WEST BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3398
Mailing Address - Country:US
Mailing Address - Phone:865-693-3499
Mailing Address - Fax:865-693-5938
Practice Address - Street 1:220 FORT SANDERS WEST BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3398
Practice Address - Country:US
Practice Address - Phone:865-693-3499
Practice Address - Fax:865-693-5938
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD340142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00224507OtherRRM
3854272Medicare PIN
TNG18525Medicare UPIN