Healthcare Provider Details

I. General information

NPI: 1528003829
Provider Name (Legal Business Name): JOSEPH F LOOBY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4017 RAWLINS ST
CHEYENNE WY
82001-1800
US

IV. Provider business mailing address

PO BOX 20970
CHEYENNE WY
82003-7020
US

V. Phone/Fax

Practice location:
  • Phone: 307-638-8987
  • Fax: 307-638-7829
Mailing address:
  • Phone: 307-996-4777
  • Fax: 307-773-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11027A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number5101012652
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number11027A
License Number StateWY
# 4
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number11027A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: