Provider Demographics
NPI:1285645523
Name:LOOMIS, WILLIAM ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:LOOMIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:111 E CENTRAL AVE
Mailing Address - Street 2:STE B
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-1108
Mailing Address - Country:US
Mailing Address - Phone:509-487-1500
Mailing Address - Fax:509-487-1535
Practice Address - Street 1:111 E CENTRAL AVE
Practice Address - Street 2:STE B
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1108
Practice Address - Country:US
Practice Address - Phone:509-487-1500
Practice Address - Fax:509-487-1535
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP00000894204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
A07289Medicare UPIN