Provider Demographics
NPI:1467453720
Name:LOISEAU, JEAN-CLAUDE (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN-CLAUDE
Middle Name:
Last Name:LOISEAU
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 1:1264 WESLEY DR
Mailing Address - Street 2:STE 304
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6400
Mailing Address - Country:US
Mailing Address - Phone:901-398-1990
Mailing Address - Fax:901-398-1996
Practice Address - Street 1:1264 WESLEY DR
Practice Address - Street 2:STE 304
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6400
Practice Address - Country:US
Practice Address - Phone:901-398-1990
Practice Address - Fax:901-398-1996
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30033208600000X
MS17160208600000X
OH35045444L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0122348Medicaid
MS9015315Medicaid
0482986007OtherCIGNA ID #
TN3088094OtherBC BS #
TN4280919OtherAETNA ID #
MS020000447Medicare ID - Type UnspecifiedMS MCARE #
TN3088094OtherBC BS #
A80112Medicare UPIN
TN3821602Medicare ID - Type UnspecifiedMEDICARE #