Basic Information
| Provider Information | |||||||||
| NPI: | 1447247994 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAMOTTE | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12687 W CEDAR DR | ||||||||
| Address2: | 200 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802282014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034681395 | ||||||||
| FaxNumber: | 3034681394 | ||||||||
| Practice Location | |||||||||
| Address1: | 1397 WEIMER RD | ||||||||
| Address2: | |||||||||
| City: | TAOS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875716253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5757588883 | ||||||||
| FaxNumber: | 3034681394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 01/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 22047 | NE | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | G5279 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 28061 | CO | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 84-209 | NM | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | 84-209 | NM | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 10025709000 | 05 | NE | MEDICAID | P00720336 | 01 | NE | RR MCR NE | OTHER | 0255069 | 01 | WA | DOL WASHINGTON | OTHER | 0259639 | 01 | WA | DOL WA RIN | OTHER | 1447247994 | 05 | WY | MEDICAID | 1447247994/7726790 | 05 | SD | MEDICAID | 000W6165 | 05 | NM | MEDICAID |