Provider Demographics
NPI:1194904755
Name:LOEB, LOLA J (MD)
Entity type:Individual
Prefix:
First Name:LOLA
Middle Name:J
Last Name:LOEB
Suffix:
Gender:F
Credentials:MD
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Other - Middle Name:
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Mailing Address - Street 1:5471 DR. MARTIN LUTHER KING DR.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-4265
Mailing Address - Country:US
Mailing Address - Phone:314-367-5820
Mailing Address - Fax:314-367-6326
Practice Address - Street 1:5471 DR. MARTIN LUTHER KING DR.
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-4265
Practice Address - Country:US
Practice Address - Phone:314-367-5820
Practice Address - Fax:314-367-6326
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2010-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO20100003513207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics