Healthcare Provider Details

I. General information

NPI: 1841490414
Provider Name (Legal Business Name): DAVID J LOISELLE, DPM, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/20/2010
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 TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1880
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1880
License Number StateFL

VIII. Authorized Official

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