Individual
MRS. AUTUMN M LOOMIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 HOSPITAL DR, KETCHUM, ID 83340
(208) 727-8100
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
46501
KY
207P00000X
Emergency Medicine Physician
Primary
M-16646
ID
Other
Enumeration date
04/05/2010
Last updated
07/26/2022
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