Basic Information
| Provider Information | |||||||||
| NPI: | 1770711681 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOCH | ||||||||
| FirstName: | ELI | ||||||||
| MiddleName: | STEVEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 WELLS RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320732982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042826331 | ||||||||
| FaxNumber: | 9046191080 | ||||||||
| Practice Location | |||||||||
| Address1: | 463386 S.R. 200 | ||||||||
| Address2: | UNIT A | ||||||||
| City: | YULEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044683080 | ||||||||
| FaxNumber: | 9044683193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2009 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | UO#: 2122 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | OS12026 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 011838700 | 05 | FL | MEDICAID | 14U2V | 01 | FL | BCBS | OTHER |