Provider Demographics
NPI:1194729749
Name:LOFTON, SAMUEL C III (PA-C)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:C
Last Name:LOFTON
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2139
Mailing Address - Country:US
Mailing Address - Phone:440-324-5588
Mailing Address - Fax:440-324-2075
Practice Address - Street 1:4804 LEAVITT RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2139
Practice Address - Country:US
Practice Address - Phone:440-324-5588
Practice Address - Fax:440-324-2075
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1059451363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00050528OtherRAILROAD MEDICARE
OH128429100OtherFEDERAL WORKERS COMP
OH000000324024OtherANTHEM
OH128429100OtherFEDERAL WORKERS COMP