Provider Demographics
NPI:1366471286
Name:VANLOOCK, JOHN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SCOTT
Last Name:VANLOOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:SCOTT
Other - Last Name:VANLOOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6163 OMNI PARK DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-5195
Mailing Address - Country:US
Mailing Address - Phone:251-635-1315
Mailing Address - Fax:251-635-1210
Practice Address - Street 1:6163 OMNI PARK DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-5195
Practice Address - Country:US
Practice Address - Phone:251-635-1315
Practice Address - Fax:251-635-1210
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2014-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23602207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH81899Medicare UPIN
AL51553512Medicare ID - Type Unspecified