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Individual

BRYAN D LOOS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
960 CLAGUE RD STE 110B, WESTLAKE, OH 44145-1582
(440) 250-5366
Mailing address
960 CLAGUE RD, WESTLAKE, OH 44145-1582
(440) 250-5366

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35062747
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0119204
GROUP MEDICAID
01
080167222
RR MEDICARE INDIVIDUAL
01
107559
KAISER
01
10795128
CAQH
01
1780634279
GROUP NPI
01
CA4511
RR MEDICARE GROUP
Enumeration date
03/07/2006
Last updated
01/08/2021
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