Provider Demographics
NPI:1629321666
Name:JEFFREY B LOOMER, MD, PC
Entity Type:Organization
Organization Name:JEFFREY B LOOMER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOOMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-575-7511
Mailing Address - Street 1:1925 W ORANGE GROVE RD
Mailing Address - Street 2:STE 106
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1143
Mailing Address - Country:US
Mailing Address - Phone:520-575-7511
Mailing Address - Fax:520-575-9815
Practice Address - Street 1:1925 W ORANGE GROVE RD
Practice Address - Street 2:STE 106
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1143
Practice Address - Country:US
Practice Address - Phone:520-575-7511
Practice Address - Fax:520-575-9815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20557207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF29968Medicare UPIN