Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 05015 | IA |
NPI | 1053652883 |
---|---|
Provider Name | Dr. Jason Thomas Losee |
First Address | Sergeant Bluff, IA 51054-1240 |
Second Address | Sergeant Bluff, IA 51054-7729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2013 |
Last Update Date | 19/07/2017 |