Provider Demographics
NPI:1174707921
Name:LOOMIS MEDICAL CLINIC
Entity type:Organization
Organization Name:LOOMIS MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GRAMM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:916-652-0427
Mailing Address - Street 1:6135 KING RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-8877
Mailing Address - Country:US
Mailing Address - Phone:916-652-0427
Mailing Address - Fax:916-652-4197
Practice Address - Street 1:6135 KING RD
Practice Address - Street 2:SUITE A
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-8877
Practice Address - Country:US
Practice Address - Phone:916-652-0427
Practice Address - Fax:916-652-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ94479ZOtherMEDICARE
CAE08782Medicare UPIN