Organization
PACIFIC NORTHWEST RADIOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BURT LOESSBERG (CEO)
(541) 687-7134
Entity
Organization
Contact information
Practice address
602 CHASE AVENUE, CORDOVA, AK 99574-0160
(907) 424-8000
Mailing address
PO BOX 26570, FRESNO, CA 93729-6570
(541) 687-7134
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7140551
—
WA
05
—
MDG34OR
—
OR
Enumeration date
04/29/2008
Last updated
04/29/2008
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