Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 000792 | MO |
NPI | 1316946940 |
---|---|
Provider Name | Dr. Ronald James Loucks |
First Address | Festus, MO 63028-2323 |
Second Address | Festus, MO 63028-2323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 04/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124083 | BLUE CROSS/BLUE SHIELD (01) | MO |
408100 | HEALTHLINK (01) | MO |
P00184813 | RAILROAD MEDICARE (01) | MO |
U73219 | (02) | MO |