Basic Information
| Provider Information | |||||||||
| NPI: | 1851520431 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOMOTEY | ||||||||
| FirstName: | CHAYLAH | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1406 COLLEGE DR 1 | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755033580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036147693 | ||||||||
| FaxNumber: | 9036145343 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | RAYMONDVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785803521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566895506 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2009 | ||||||||
| LastUpdateDate: | 11/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N3150 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 282617401 | 05 | TX | MEDICAID |