Healthcare Provider Details

I. General information

NPI: 1760587018
Provider Name (Legal Business Name): RICHARD B LOOMIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3288 BELL RD
AUBURN CA
95603-9243
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD SUITE 100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 530-886-2300
  • Fax: 530-886-2301
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG64311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: