Provider Demographics
NPI:1598820318
Name:LOOMIS, JOHN HOWARD III (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HOWARD
Last Name:LOOMIS
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1130 E 965 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4371
Mailing Address - Country:US
Mailing Address - Phone:801-221-5819
Mailing Address - Fax:801-221-5819
Practice Address - Street 1:3336 PIONEER PKWY
Practice Address - Street 2:#204
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2000
Practice Address - Country:US
Practice Address - Phone:801-964-3249
Practice Address - Fax:801-964-3749
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT275384-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTF31246Medicare UPIN