Healthcare Provider Details

I. General information

NPI: 1386273233
Provider Name (Legal Business Name): JAMES RENWICK LOOMIS III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 EARHART DR
WILLIAMSVILLE NY
14221-7801
US

IV. Provider business mailing address

8205 MAIN ST STE 10
WILLIAMSVILLE NY
14221-6054
US

V. Phone/Fax

Practice location:
  • Phone: 716-565-9030
  • Fax: 716-250-9090
Mailing address:
  • Phone: 716-539-0789
  • Fax: 716-250-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number322716
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: