Provider Demographics
NPI:1891943825
Name:LOEFFLER, MICHAEL JACOB (INDEPENDENT DUTY HM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JACOB
Last Name:LOEFFLER
Suffix:
Gender:M
Credentials:INDEPENDENT DUTY HM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 MORRIS ST
Mailing Address - Street 2:BLDG Z101
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23511-3427
Mailing Address - Country:US
Mailing Address - Phone:757-443-0007
Mailing Address - Fax:
Practice Address - Street 1:1959 MORRIS ST
Practice Address - Street 2:BLDG Z101
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-3427
Practice Address - Country:US
Practice Address - Phone:757-443-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman