Basic Information
| Provider Information | |||||||||
| NPI: | 1487915526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOFTUS | ||||||||
| FirstName: | TYLER | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100109 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522650761 | ||||||||
| FaxNumber: | 3522650190 | ||||||||
| Practice Location | |||||||||
| Address1: | SHANDS AT THE UNIVERSITY OF FLORIDA | ||||||||
| Address2: | 1600 SW ARCHER ROAD | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522650916 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2012 | ||||||||
| LastUpdateDate: | 12/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 17242 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | ME141907 | FL | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 107435200 | 05 | FL | MEDICAID |