Basic Information
| Provider Information | |||||||||
| NPI: | 1801862826 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOTT | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 57915 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841570915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003283054 | ||||||||
| FaxNumber: | 8012846828 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 N WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456012420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407794500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 02/05/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35062108 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 33892 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64010341 | 05 | KY | MEDICAID |