Provider Demographics
NPI:1366415424
Name:LOESSIN, SCOTT J (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:J
Last Name:LOESSIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 NORTHSIDE DR
Mailing Address - Street 2:BLDG A
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-8011
Mailing Address - Country:US
Mailing Address - Phone:305-809-8011
Mailing Address - Fax:305-809-8011
Practice Address - Street 1:3140 NORTHSIDE DR
Practice Address - Street 2:BLDG A
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-8011
Practice Address - Country:US
Practice Address - Phone:305-809-8011
Practice Address - Fax:305-809-8011
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067948208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377730800Medicaid
FL377730800Medicaid