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Individual

VICTOR E. DE LOACH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5045 FRUITVILLE RD UNIT 123B, SARASOTA, FL 34232-2269
(772) 203-4613
(727) 290-4383
Mailing address
782 PLYMOUTH ST UNIT 12, HOLBROOK, MA 02343-1952

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD.19935
AL
207V00000X
Obstetrics & Gynecology Physician
78151
FL
208D00000X
General Practice Physician
Primary
ME78151
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
022825500
FL
05
131855
AL
05
132989
AL
01
266278
AVMED
FL
01
5474634
AETNA
FL
01
58949
FLORIDA BLUE
FL
Enumeration date
10/20/2005
Last updated
06/22/2021
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