Provider Demographics
NPI:1104843796
Name:HUGHES, LOREN (MD)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:HUGHES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 VANDALIA ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4846
Mailing Address - Country:US
Mailing Address - Phone:618-344-3046
Mailing Address - Fax:618-344-5284
Practice Address - Street 1:1950 VANDALIA ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4846
Practice Address - Country:US
Practice Address - Phone:618-344-3046
Practice Address - Fax:618-344-5284
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-081352207P00000X
MO2001001840207P00000X
IL036081352207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081352Medicaid
IL036018352Medicaid
MO207455007Medicaid
MO963164740Medicare PIN
B53731Medicare UPIN
MO963164748Medicare PIN