MEDICARE: DR. JOHN EDWARD LOUDERMILK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01074589A	IN
2	207Q00000X	Family Medicine Physician	25027	WV
3	207Q00000X	Family Medicine Physician	ME147765	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780996918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN EDWARD LOUDERMILK MD

Provider Business Mailing Address
First Line	:	319 GREEN ACRES RD STE 101
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1170
Country	:	US
Telephone Number	:	850-243-7681
Fax Number	:	850-243-0471

Provider Business Practice Location Address
First Line	:	319 GREEN ACRES RD STE 101
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1170
Country	:	US
Telephone Number	:	850-243-7681
Fax Number	:	850-243-0471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	07/28/2021

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