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General NPI Number Information
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NPI Number | 1528371010
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Entity Type | Organization
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Legal Business Name | DAVID J LOISELLE DPM PA
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 14219 WALSINGHAM RD SUITE K
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City | LARGO
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State | FL
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Zip | 33774-3249
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Country | US
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Telephone | 727-596-9703
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Fax | 727-596-9703
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Provider Business Mailing Address
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Address Line | 14219 WALSINGHAM RD SUITE K
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City | LARGO
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State | FL
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Zip | 33774-3249
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Country | US
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Telephone | 727-596-9703
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Fax | 727-596-9703
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID JOHN LOISELLE
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Credential | DPM
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Telephone | 727-596-9703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO 1880
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 213ER0200X
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Taxonomy Name | Radiology Podiatrist
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License Number | PO 1880
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO 1880
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License Number State | FL
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Legacy Identifiers
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Identifier #1
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Identifier Code | 029762300
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Identifier Type | MEDICAID
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Identifier State | FL
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 029762300
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Identifier Type | MEDICAID
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Identifier State | FL
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Identifier Issuer |
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