Provider Demographics
NPI:1043022585
Name:LAMOTT, GAVIN
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:
Last Name:LAMOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14335 ITASCA BAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:55327-3401
Mailing Address - Country:US
Mailing Address - Phone:763-222-9845
Mailing Address - Fax:
Practice Address - Street 1:14335 ITASCA BAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:MN
Practice Address - Zip Code:55327-3401
Practice Address - Country:US
Practice Address - Phone:763-222-9845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant