Provider Demographics
NPI:1952422321
Name:LOFTUS, JEAN M (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:LOFTUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 DIXIE HWY
Mailing Address - Street 2:#300
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2624
Mailing Address - Country:US
Mailing Address - Phone:859-426-5000
Mailing Address - Fax:859-426-5002
Practice Address - Street 1:1881 DIXIE HWY
Practice Address - Street 2:#300
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011-2624
Practice Address - Country:US
Practice Address - Phone:859-426-5000
Practice Address - Fax:859-426-5002
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31416174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist