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Individual

DR. GREGORY D LOOSE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
1113 CENTRAL AVE E, WIGGINS, MS 39577-9605
(601) 928-3914
(601) 928-2207
Mailing address
1113 CENTRAL AVE E, WIGGINS, MS 39577-9605
(601) 928-3914
(601) 928-2207

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
758
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01374059
MS
Enumeration date
11/03/2006
Last updated
02/26/2008
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