Individual
JOHN S LOOMIS III
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18750 SE STARK ST, PORTLAND, OR 97233-5330
(503) 666-6717
(503) 666-6745
Mailing address
PO BOX 92900, PORTLAND, OR 97292-0900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD19850
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
079939
—
OR
Enumeration date
04/13/2006
Last updated
07/08/2007
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