Provider Demographics
NPI:1942257746
Name:MISICK, LOFTON N (MD)
Entity Type:Individual
Prefix:
First Name:LOFTON
Middle Name:N
Last Name:MISICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ID#1177
Mailing Address - Street 2:PO BOX 659506
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-9506
Mailing Address - Country:US
Mailing Address - Phone:361-761-8610
Mailing Address - Fax:361-761-8611
Practice Address - Street 1:819 AYERS ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-1914
Practice Address - Country:US
Practice Address - Phone:361-761-8610
Practice Address - Fax:361-761-8611
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ7428208G00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2029665Medicaid
TX364986503Medicaid
G57369Medicare UPIN