Individual
DR. BLAISE JACKSON LOUGHMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MB, BCH, BAO (HONS)
Contact information
Practice address
1 BARNES JEW HOSP PLZ, SAINT LOUIS, MO 63110-1003
(314) 362-9177
Mailing address
660 S EUCLID AVE # 8072, SAINT LOUIS, MO 63110-1010
(314) 362-9177
Taxonomy
Speciality
Code
Description
License number
State
146L00000X
Paramedic
166041
PA
207P00000X
Emergency Medicine Physician
Primary
2023020885
MO
Other
Enumeration date
06/19/2023
Last updated
06/19/2023
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