Provider Demographics
NPI:1639141146
Name:LOEW, RICHARD DOUGLAS (D O)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DOUGLAS
Last Name:LOEW
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4533
Mailing Address - Country:US
Mailing Address - Phone:772-288-4911
Mailing Address - Fax:772-288-0691
Practice Address - Street 1:2520 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4533
Practice Address - Country:US
Practice Address - Phone:772-288-4911
Practice Address - Fax:772-288-0691
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5429207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80527OtherBLUE CROSS & BLUE SHIELD
FL80527OtherBLUE CROSS & BLUE SHIELD
FLD89611Medicare UPIN