Provider Demographics
NPI:1134314511
Name:LOYO-MOLINA, JOSE GREGORIO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:GREGORIO
Last Name:LOYO-MOLINA
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 1:4200 JENNY LIND RD
Mailing Address - Street 2:STE. A
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-7632
Mailing Address - Country:US
Mailing Address - Phone:479-484-1010
Mailing Address - Fax:479-573-2740
Practice Address - Street 1:4200 JENNY LIND RD
Practice Address - Street 2:STE. A
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7632
Practice Address - Country:US
Practice Address - Phone:479-484-1010
Practice Address - Fax:479-573-2740
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ART2007-145207RC0000X
ARE5516207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200120720AMedicaid
AR166408001Medicaid
AR166408001Medicaid