Healthcare Provider Details

I. General information

NPI: 1528371010
Provider Name (Legal Business Name): DAVID J LOISELLE DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14219 WALSINGHAM RD SUITE K
LARGO FL
33774-3249
US

IV. Provider business mailing address

14219 WALSINGHAM RD SUITE K
LARGO FL
33774-3249
US

V. Phone/Fax

Practice location:
  • Phone: 727-596-9703
  • Fax: 727-596-9703
Mailing address:
  • Phone: 727-596-9703
  • Fax: 727-596-9703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO 1880
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberPO 1880
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 1880
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier029762300
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer

VIII. Authorized Official

Name: DR. DAVID JOHN LOISELLE
Title or Position: OWNER
Credential: DPM
Phone: 727-596-9703