Provider Demographics
NPI:1942851217
Name:LOEBER, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:LOEBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86405-0091
Mailing Address - Country:US
Mailing Address - Phone:928-230-0922
Mailing Address - Fax:
Practice Address - Street 1:2890 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-7777
Practice Address - Country:US
Practice Address - Phone:484-818-0170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion