Provider Demographics
NPI:1407862733
Name:LOUDERMILK, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:LOUDERMILK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:W
Other - Last Name:LOUDERMILK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:409 CENTRAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2069
Mailing Address - Country:US
Mailing Address - Phone:817-261-9191
Mailing Address - Fax:817-784-6880
Practice Address - Street 1:409 CENTRAL PARK DR.
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014
Practice Address - Country:US
Practice Address - Phone:817-261-9191
Practice Address - Fax:817-784-6880
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4490174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC18546Medicare UPIN
TX00LR03Medicare ID - Type Unspecified