Individual
DR. JEFFREY H LOOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1202 S TYLER ST, COVINGTON, LA 70433-2330
(985) 898-4097
(985) 871-5755
Mailing address
PO BOX 731280, DALLAS, TX 75373-1280
(318) 841-9526
(318) 841-9551
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
MD034365E
PA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD206515
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10931337
CAQH PROVIDER ID
LA
05
—
2381288
—
LA
Enumeration date
10/06/2005
Last updated
07/07/2015
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