Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 49988 | NY |
Y | 213EG0000X | General Practice | 49988 | NY |
NPI | 1003030420 |
---|---|
Provider Name | Shamus Loftus |
First Address | Naples, FL 34108-2710 |
Second Address | Port Charlotte, FL 33952-8053 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 06/06/2016 |