Provider Demographics
NPI:1538104872
Name:MIRE, LOUIS E (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:E
Last Name:MIRE
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:N BUS HWY 65
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616
Mailing Address - Country:US
Mailing Address - Phone:417-335-7218
Mailing Address - Fax:417-334-1507
Practice Address - Street 1:N BUS HWY 65
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-335-7218
Practice Address - Fax:417-334-1507
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8C50207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
126814OtherBCBS
MO208887414Medicaid
250766OtherHEALTHLINK
930028765OtherRAILROAD MEDICARE
930028765OtherRAILROAD MEDICARE
MOD84286Medicare UPIN