Healthcare Provider Details

I. General information

NPI: 1104843796
Provider Name (Legal Business Name): LOREN HUGHES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 VANDALIA ST
COLLINSVILLE IL
62234-4846
US

IV. Provider business mailing address

1950 VANDALIA ST
COLLINSVILLE IL
62234-4846
US

V. Phone/Fax

Practice location:
  • Phone: 618-344-3046
  • Fax: 618-344-5284
Mailing address:
  • Phone: 618-344-3046
  • Fax: 618-344-5284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-081352
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2001001840
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036081352
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: