Individual
JERALD T LOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
13701 ENCANTADO RD NE, ALBUQUERQUE, NM 87123-2275
(505) 237-8700
Mailing address
PO BOX 26028, ALBUQUERQUE, NM 87125-6028
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2004-0005
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18556019
—
NM
Enumeration date
07/11/2006
Last updated
04/26/2024
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