Provider Demographics
NPI:1932106390
Name:LOEB, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:LOEB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:120 LA CASA VIA
Mailing Address - Street 2:STE 204
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3007
Mailing Address - Country:US
Mailing Address - Phone:925-210-1050
Mailing Address - Fax:921-210-1082
Practice Address - Street 1:120 LA CASA VIA
Practice Address - Street 2:STE 204
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3007
Practice Address - Country:US
Practice Address - Phone:925-210-1050
Practice Address - Fax:921-210-1082
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2010-07-28
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Provider Licenses
StateLicense IDTaxonomies
CAG29097207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G290970Medicaid
CA00G290971Medicare ID - Type Unspecified
CAA43953Medicare UPIN