Provider Demographics
NPI:1437120706
Name:LOUGHREY, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:LOUGHREY
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:PO BOX 632551
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2551
Mailing Address - Country:US
Mailing Address - Phone:513-681-8800
Mailing Address - Fax:513-681-6999
Practice Address - Street 1:5215 N BEND RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-8006
Practice Address - Country:US
Practice Address - Phone:513-681-8800
Practice Address - Fax:513-681-6999
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33596207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH102530944OtherMEDICARE RAILROAD
OH0309884Medicaid
OH102530944OtherMEDICARE RAILROAD
OH0397602Medicare PIN