Healthcare Provider Details

I. General information

NPI: 1437120706
Provider Name (Legal Business Name): JOHN R LOUGHREY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 N BEND RD
CINCINNATI OH
45247-8006
US

IV. Provider business mailing address

PO BOX 632551
CINCINNATI OH
45263-2551
US

V. Phone/Fax

Practice location:
  • Phone: 513-681-8800
  • Fax: 513-681-6999
Mailing address:
  • Phone: 513-681-8800
  • Fax: 513-681-6999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number33596
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: