Healthcare Provider Details

I. General information

NPI: 1255889697
Provider Name (Legal Business Name): DONALD ANDREW LOOMIS, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 N WASHINGTON ST
TACOMA WA
98406-5841
US

IV. Provider business mailing address

2517 N WASHINGTON ST
TACOMA WA
98406-5841
US

V. Phone/Fax

Practice location:
  • Phone: 253-759-3586
  • Fax: 253-759-5746
Mailing address:
  • Phone: 253-759-3586
  • Fax: 253-759-5746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00020081
License Number StateWA

VIII. Authorized Official

Name: ANDREW LOOMIS
Title or Position: OWNER
Credential: MD
Phone: 253-759-8970