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General NPI Number Information
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NPI Number | 1275632176
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Entity Type | Organization
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Legal Business Name | SCOTT J LOESSIN MD LLC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 311 N CLYDE MORRIS BLVD SUITE 510
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2781
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Country | US
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Telephone | 386-258-3223
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Fax | 386-252-8237
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Provider Business Mailing Address
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Address Line | 311 N CLYDE MORRIS BLVD 510
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2781
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Country | US
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Telephone | 386-258-3223
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Fax | 386-252-8237
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SCOTT J LOESSIN
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Credential | MD
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Telephone | 386-258-3223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME0067948
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License Number State | FL
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