Healthcare Provider Details

I. General information

NPI: 1366415424
Provider Name (Legal Business Name): SCOTT J. LOESSIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 NORTHSIDE DR BLDG A
KEY WEST FL
33040-8011
US

IV. Provider business mailing address

3140 NORTHSIDE DR BLDG A
KEY WEST FL
33040-8011
US

V. Phone/Fax

Practice location:
  • Phone: 305-809-8011
  • Fax: 305-809-8011
Mailing address:
  • Phone: 305-809-8011
  • Fax: 305-809-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME0067948
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: