Provider Demographics
NPI:1457585127
Name:LOOMIS, STEVEN WALTER (IDMT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:WALTER
Last Name:LOOMIS
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:31933 ROSEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532
Mailing Address - Country:US
Mailing Address - Phone:951-655-5167
Mailing Address - Fax:951-655-7389
Practice Address - Street 1:752MDS
Practice Address - Street 2:MARCH ARB
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92518-5000
Practice Address - Country:US
Practice Address - Phone:951-655-3832
Practice Address - Fax:951-655-7389
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians