Provider Demographics
NPI:1356319537
Name:LOISELLE, DAVID JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:LOISELLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14219 WALSINGHAM RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3249
Mailing Address - Country:US
Mailing Address - Phone:727-596-9703
Mailing Address - Fax:727-596-9703
Practice Address - Street 1:14219 WALSINGHAM RD
Practice Address - Street 2:SUITE K
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3249
Practice Address - Country:US
Practice Address - Phone:727-596-9703
Practice Address - Fax:727-596-9703
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1880213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029762300Medicaid
FL029762300Medicaid
FL0356570001Medicare NSC
FL65051Medicare ID - Type Unspecified