Healthcare Provider Details

I. General information

NPI: 1053652883
Provider Name (Legal Business Name): JASON THOMAS LOSEE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 SUNNYBROOK DR
SIOUX CITY IA
51106-4250
US

IV. Provider business mailing address

5885 SUNNYBROOK DR
SIOUX CITY IA
51106-4250
US

V. Phone/Fax

Practice location:
  • Phone: 712-266-2700
  • Fax: 712-266-2719
Mailing address:
  • Phone: 712-266-2700
  • Fax: 712-266-2719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number05015
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05015
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: