Provider Demographics
NPI:1871502435
Name:LOEB, ROBERT SHANE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SHANE
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 1:1516 COTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3303
Mailing Address - Country:US
Mailing Address - Phone:310-445-2951
Mailing Address - Fax:310-479-1459
Practice Address - Street 1:1516 COTNER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3303
Practice Address - Country:US
Practice Address - Phone:310-445-2951
Practice Address - Fax:310-479-1459
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV100492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX048835506Medicaid
CA1871502435Medicaid
TX8A0632Medicare PIN
CAA0844SMedicare PIN
CAA0844UMedicare PIN
CAAO844YMedicare PIN
CAAR023ZMedicare PIN
CAAO844XMedicare PIN
CAAO844ZMedicare PIN
CA1871502435Medicaid
TX048835506Medicaid
CAA0844TMedicare PIN
CAAW968ZMedicare PIN
CAWC53042AMedicare PIN
CAWC53042BMedicare PIN
CA00C530420Medicare PIN
CA00C530421Medicare PIN