Provider Demographics
NPI:1215271341
Name:LOOSEN, PETER T (MD)
Entity type:Individual
Prefix:PROF
First Name:PETER
Middle Name:T
Last Name:LOOSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LOWRY STREET
Mailing Address - Street 2:APT 5E
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483
Mailing Address - Country:US
Mailing Address - Phone:561-265-1166
Mailing Address - Fax:
Practice Address - Street 1:1000 LOWRY ST
Practice Address - Street 2:APT 5E
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-7039
Practice Address - Country:US
Practice Address - Phone:561-265-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD173862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry