Healthcare Provider Details

I. General information

NPI: 1942799390
Provider Name (Legal Business Name): ALEXANDER LOOMIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEX LOOMIS DO

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1873
US

IV. Provider business mailing address

PO BOX 3123
INDIANAPOLIS IN
46206-3123
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3000
  • Fax:
Mailing address:
  • Phone: 937-621-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number34.016395
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: