Provider Demographics
NPI:1790006294
Name:LOOMIS, JAMES A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:LOOMIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5100 W TAFT RD
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3807
Mailing Address - Country:US
Mailing Address - Phone:315-452-2828
Mailing Address - Fax:315-452-2509
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-452-2828
Practice Address - Fax:315-452-2509
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2013-12-03
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Provider Licenses
StateLicense IDTaxonomies
NY271012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03656291Medicaid