Provider Demographics
NPI:1407898919
Name:LOFTUS, GREG R (RD)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:R
Last Name:LOFTUS
Suffix:
Gender:M
Credentials:RD
Other - Prefix:MR
Other - First Name:GREG
Other - Middle Name:
Other - Last Name:LOFTUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:86 DOW RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-8803
Mailing Address - Country:US
Mailing Address - Phone:307-672-3473
Mailing Address - Fax:
Practice Address - Street 1:1898 FORT RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-8320
Practice Address - Country:US
Practice Address - Phone:307-672-3473
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered