Provider Demographics
NPI:1417301789
Name:LOEB, ALEXANDER EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:EDWARD
Last Name:LOEB
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 1:1911 MICCOSUKEE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5321
Mailing Address - Country:US
Mailing Address - Phone:850-878-2549
Mailing Address - Fax:850-878-9347
Practice Address - Street 1:1911 MICCOSUKEE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5321
Practice Address - Country:US
Practice Address - Phone:850-878-2549
Practice Address - Fax:850-878-9347
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2772207X00000X
ALMD.42241207X00000X, 207XX0005X
FLME157005207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine