Provider Demographics
NPI:1679565980
Name:LOOTENS, ROBERT JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JEFFREY
Last Name:LOOTENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:85 SPRING STREET
Mailing Address - Street 2:SUITE 2A1
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3113
Mailing Address - Country:US
Mailing Address - Phone:603-524-1600
Mailing Address - Fax:603-524-2945
Practice Address - Street 1:85 SPRING STREET
Practice Address - Street 2:SUITE 2A1
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3113
Practice Address - Country:US
Practice Address - Phone:603-524-1600
Practice Address - Fax:603-524-2945
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH14386207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB44651Medicare UPIN