Provider Demographics
NPI:1114531407
Name:LOOMIS, LOGAN HURST (PA-C)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:HURST
Last Name:LOOMIS
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:30539 WYNDHAM CT
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-2701
Mailing Address - Country:US
Mailing Address - Phone:951-837-5279
Mailing Address - Fax:
Practice Address - Street 1:31571 CANYON ESTATES DR STE 100
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-0471
Practice Address - Country:US
Practice Address - Phone:951-397-4214
Practice Address - Fax:951-245-8880
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2022-11-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant