| Entity Name: | W. ERIC LOCH, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 12 May 2009 (16 years ago) |
| Date of dissolution: | 25 Sep 2015 (9 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2015 (9 years ago) |
| Document Number: | P09000042311 |
| FEI/EIN Number | 300566655 |
| Address: | 4551 WEST U.S HWY 90, STE 101, LAKE CITY, FL, 32055 |
| Mail Address: | 4551 WEST U.S HWY 90, STE 101, LAKE CITY, FL, 32055 |
| ZIP code: | 32055 |
| County: | Columbia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962739334 | 2009-11-05 | 2009-11-05 | 4551 W US HIGHWAY 90, SUITE101, LAKE CITY, FL, 320558835, US | 4551 W US HIGHWAY 90, SUITE 101, LAKE CITY, FL, 320558836, US | |||||||||||||||||||||||||
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| Phone | +1 386-719-9993 |
| Fax | 3867194744 |
Authorized person
| Name | DR. WALTER ERIC LOCH |
| Role | PRESIDENT |
| Phone | 3867199993 |
Taxonomy
| Taxonomy Code | 207Y00000X - Otolaryngology Physician |
| License Number | ME102204 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS AND BLUE SHIELD |
| Number | 52026 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LOCH ERIC | Agent | 2236 NW 27TH LANE, GAINESVILLE, FL, 32605 |
| Name | Role | Address |
|---|---|---|
| LOCH ERIC | President | 2236 NW 27TH LANE, GAINESVILLE, FL, 32605 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-02-01 | 4551 WEST U.S HWY 90, STE 101, LAKE CITY, FL 32055 | No data |
| CHANGE OF MAILING ADDRESS | 2010-02-01 | 4551 WEST U.S HWY 90, STE 101, LAKE CITY, FL 32055 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2014-05-06 |
| ANNUAL REPORT | 2013-04-16 |
| ANNUAL REPORT | 2012-01-06 |
| ANNUAL REPORT | 2011-06-23 |
| ANNUAL REPORT | 2010-02-01 |
| Domestic Profit | 2009-05-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
