Provider Demographics
NPI:1104899103
Name:LOOMIS, JAMES C (DPM)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:LOOMIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:PA
Mailing Address - Zip Code:18434-1024
Mailing Address - Country:US
Mailing Address - Phone:570-383-4958
Mailing Address - Fax:570-383-3018
Practice Address - Street 1:322 CHURCH ST
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:PA
Practice Address - Zip Code:18434-1024
Practice Address - Country:US
Practice Address - Phone:570-383-4958
Practice Address - Fax:570-383-3018
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-003449-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012410720003Medicaid
PA0012410720003Medicaid
PA669273Medicare ID - Type Unspecified