Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 01039263A | IN |
NPI | 1093030322 |
---|---|
Provider Name | Dr. Gregory J Loomis |
First Address | Evansville, IN 47725-9596 |
Second Address | Evansville, IN 47725-9596 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2010 |
Last Update Date | 30/03/2010 |