Provider Demographics
NPI:1407815582
Name:LOCH, WALTER ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:ERIC
Last Name:LOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:701 MANATEE AVE W
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8604
Mailing Address - Country:US
Mailing Address - Phone:941-748-2455
Mailing Address - Fax:941-750-9704
Practice Address - Street 1:701 MANATEE AVE W
Practice Address - Street 2:SUITE 202
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8604
Practice Address - Country:US
Practice Address - Phone:941-748-2455
Practice Address - Fax:941-750-9704
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME102204207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1962739334OtherFL MEDICARE
FL52026OtherBCBS FLORIDA