Provider Demographics
NPI:1548320583
Name:LOURA, DENNIS CHAVES (NP-C)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:CHAVES
Last Name:LOURA
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 DIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-4399
Mailing Address - Country:US
Mailing Address - Phone:508-880-9130
Mailing Address - Fax:
Practice Address - Street 1:1401 DESHLER ST SW
Practice Address - Street 2:
Practice Address - City:FT MCPHERSON
Practice Address - State:GA
Practice Address - Zip Code:30330-1040
Practice Address - Country:US
Practice Address - Phone:770-968-6306
Practice Address - Fax:678-422-2378
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALO NP4266Medicare ID - Type Unspecified
MAP97079Medicare UPIN