Provider Demographics
NPI:1316942584
Name:LOONEY, JEFFREY RAY (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RAY
Last Name:LOONEY
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:PO BOX 4000
Mailing Address - Street 2:(112)
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-4000
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF LAMONT AND VETERAN'S WAY
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-2696
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29974207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316942584Medicaid
TN3821264Medicaid
TN3700592Medicare UPIN
TN0281780003Medicare PIN
TN38212622Medicare UPIN
TN3821264Medicaid
TN103I086169Medicare UPIN
VA1316942584Medicaid
TN0281780001Medicare PIN