Individual
PAUL LOOSEMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4059 CASTLEMAN AVE, SAINT LOUIS, MO 63110-3617
(314) 484-6568
Mailing address
4059 CASTLEMAN AVE, ST LOUIS, MO 63110
(314) 484-6568
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
2015030525
MO
Other
Enumeration date
09/23/2016
Last updated
09/23/2016
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