Provider Demographics
NPI:1518063288
Name:LOERA, JOSE LUIS (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:LOERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:LUIS
Other - Last Name:LOERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6810 W KENNEWICK AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1728
Mailing Address - Country:US
Mailing Address - Phone:509-737-1492
Mailing Address - Fax:509-737-1494
Practice Address - Street 1:900 S AUBURN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5621
Practice Address - Country:US
Practice Address - Phone:509-586-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022873207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0175953OtherSTATE L&I PROVIDER #
WA8103228Medicaid
WA0175953OtherSTATE L&I PROVIDER #
WA8103228Medicaid