Provider Demographics
NPI:1336421429
Name:DOWLING, LORAN EZRA JR (MSOM)
Entity Type:Individual
Prefix:MR
First Name:LORAN
Middle Name:EZRA
Last Name:DOWLING
Suffix:JR
Gender:M
Credentials:MSOM
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Mailing Address - Street 1:911 MILWAUKEE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-2117
Mailing Address - Country:US
Mailing Address - Phone:414-762-5775
Mailing Address - Fax:414-762-5895
Practice Address - Street 1:911 MILWAUKEE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-2117
Practice Address - Country:US
Practice Address - Phone:414-762-5775
Practice Address - Fax:414-762-5895
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI454-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist