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Individual

MR. MILTON WILLIAM LOOSMORE III

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CRM

Contact information

Practice address
10580 SE WASHINGTON ST, PORTLAND, OR 97216-2809
(503) 737-7365
Mailing address
10580 SE WASHINGTON ST, PORTLAND, OR 97216-2809

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
15-CRM-173
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
175T00000X
OR
Enumeration date
11/23/2015
Last updated
11/23/2015
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