Provider Demographics
NPI:1083877252
Name:LOOMIS, CARLTON ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLTON
Middle Name:ADAM
Last Name:LOOMIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911416
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-1416
Mailing Address - Country:US
Mailing Address - Phone:970-668-5584
Mailing Address - Fax:970-262-2196
Practice Address - Street 1:360 PEAK ONE DRIVE
Practice Address - Street 2:STE #260
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-5584
Practice Address - Fax:907-262-2196
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48104208000000X
CO51965208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics