Provider Demographics
NPI:1578691622
Name:LOUGHRAN, JOHN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:LOUGHRAN
Suffix:JR
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 1:5200 COMMERCE CROSSINGS DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2182
Mailing Address - Country:US
Mailing Address - Phone:502-253-4924
Mailing Address - Fax:502-489-5750
Practice Address - Street 1:3900 KRESGE WAY STE 60
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4690
Practice Address - Country:US
Practice Address - Phone:502-893-7710
Practice Address - Fax:502-893-1391
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43148207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000057043HOtherHUMANA
KY00533016OtherMEDICARE NIS
KYP00460520OtherRAILROAD MEDICARE
KY094508OtherSIHO
KY000000622490OtherANTHEM
IN200969410Medicaid
KY3726615000OtherPASSPORT ADVANTAGE
000000531701OtherANTHEM - NICC
KY50024877OtherPASSPORT
KY710005870Medicaid
KY094508OtherSIHO
KY00533016Medicare UPIN