Provider Demographics
NPI:1659360485
Name:LOO, GREGORY T (DPM)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:T
Last Name:LOO
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Gender:M
Credentials:DPM
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Mailing Address - Street 1:13838 S 46TH PL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-7800
Mailing Address - Country:US
Mailing Address - Phone:480-213-3011
Mailing Address - Fax:480-816-4483
Practice Address - Street 1:13838 S 46TH PL
Practice Address - Street 2:SUITE 210
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-7800
Practice Address - Country:US
Practice Address - Phone:480-213-3011
Practice Address - Fax:480-816-4483
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2016-05-19
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Provider Licenses
StateLicense IDTaxonomies
AZ0502213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU75261Medicare UPIN
AZ0834030001Medicare NSC