Provider Demographics
NPI:1659929040
Name:RANDALL B LOCH MD PC
Entity Type:Organization
Organization Name:RANDALL B LOCH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:BP
Authorized Official - Last Name:LOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-541-5692
Mailing Address - Street 1:2423 NW TROOST ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1706
Mailing Address - Country:US
Mailing Address - Phone:541-677-3400
Mailing Address - Fax:541-677-3405
Practice Address - Street 1:2423 NW TROOST ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1706
Practice Address - Country:US
Practice Address - Phone:541-677-3400
Practice Address - Fax:541-677-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty