Provider Demographics
NPI:1700835329
Name:LOOMIS, DONALD ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ANDREW
Last Name:LOOMIS
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 1:2517 N WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-5841
Mailing Address - Country:US
Mailing Address - Phone:253-759-3586
Mailing Address - Fax:253-759-5746
Practice Address - Street 1:2517 N WASHINGTON
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-5841
Practice Address - Country:US
Practice Address - Phone:253-759-3586
Practice Address - Fax:253-759-5746
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1228204Medicaid
WA1228204Medicaid
WAG001000675Medicare PIN