Provider Demographics
NPI:1316416159
Name:LOXTERMAN, BRIAN MOSES
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MOSES
Last Name:LOXTERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4567 TURNEY RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-9773
Mailing Address - Country:US
Mailing Address - Phone:440-840-3761
Mailing Address - Fax:
Practice Address - Street 1:4567 TURNEY RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-9773
Practice Address - Country:US
Practice Address - Phone:440-840-3761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-23
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006505363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant