Healthcare Provider Details

I. General information

NPI: 1003824442
Provider Name (Legal Business Name): JEFFREY BRIAN LOOMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W ORANGE GROVE RD STE 104
TUCSON AZ
85704-1140
US

IV. Provider business mailing address

4550 E BELL RD STE 170
PHOENIX AZ
85032-9385
US

V. Phone/Fax

Practice location:
  • Phone: 480-443-8400
  • Fax: 480-443-8697
Mailing address:
  • Phone: 480-443-8400
  • Fax: 480-443-8697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number20557
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: