Provider Demographics
NPI:1851499461
Name:LOOT, JESSE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:L
Last Name:LOOT
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 1:430 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-3414
Mailing Address - Country:US
Mailing Address - Phone:304-469-8651
Mailing Address - Fax:304-929-2473
Practice Address - Street 1:430 MAIN ST W
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-3414
Practice Address - Country:US
Practice Address - Phone:304-469-8651
Practice Address - Fax:304-929-2473
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11588207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVD49285Medicare UPIN