1386273233 NPI number — DR. JAMES RENWICK LOOMIS III DO

Table of content: DR. JAMES RENWICK LOOMIS III DO (NPI 1386273233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386273233 NPI number — DR. JAMES RENWICK LOOMIS III DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOOMIS
Provider First Name:
JAMES
Provider Middle Name:
RENWICK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386273233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8205 MAIN ST STE 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-6054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-539-0789
Provider Business Mailing Address Fax Number:
716-250-9090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2733 WEHRLE DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221-7348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-631-3510
Provider Business Practice Location Address Fax Number:
716-631-9427
Provider Enumeration Date:
04/03/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 322716 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)