Basic Information
| Provider Information | |||||||||
| NPI: | 1912025594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOTCHAN | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8340 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631472333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143859563 | ||||||||
| FaxNumber: | 3143859350 | ||||||||
| Practice Location | |||||||||
| Address1: | 8340 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631472333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143859563 | ||||||||
| FaxNumber: | 3143859350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 11/07/2011 | ||||||||
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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 | 2083X0100X | 6154 | MO | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.