Healthcare Provider Details

I. General information

NPI: 1932034345
Provider Name (Legal Business Name): LOUDERMILK MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4608 OPA LOCKA LN STE 300
DESTIN FL
32541-0745
US

IV. Provider business mailing address

4608 OPA LOCKA LN STE 300
DESTIN FL
32541-0745
US

V. Phone/Fax

Practice location:
  • Phone: 850-270-7141
  • Fax: 448-203-3818
Mailing address:
  • Phone: 850-270-7141
  • Fax: 448-203-3818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN E LOUDERMILK
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 304-730-2975