Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 20557 | AZ |
NPI | 1003824442 |
---|---|
Provider Name | Jeffrey Brian Loomer |
First Address | Tucson, AZ 85704 |
Second Address | Tucson, AZ 85704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110990 | (05) | AZ |
F29968 | (02) |