Provider Demographics
NPI:1619936168
Name:LOOS, GERALD DEE (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:DEE
Last Name:LOOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 MILLS CIVIC PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8345
Mailing Address - Country:US
Mailing Address - Phone:515-224-9666
Mailing Address - Fax:515-224-5913
Practice Address - Street 1:6010 MILLS CIVIC PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8345
Practice Address - Country:US
Practice Address - Phone:515-224-9666
Practice Address - Fax:515-224-5913
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1039370Medicaid
IA1619936168Medicaid
IA1619936168Medicaid
IA719260350Medicare PIN
IA080076109Medicare PIN
IA19690Medicare PIN