Provider Demographics
NPI:1447247994
Name:LAMOTTE, GARY A (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:LAMOTTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12687 W CEDAR DR
Mailing Address - Street 2:200
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2014
Mailing Address - Country:US
Mailing Address - Phone:303-468-1395
Mailing Address - Fax:303-468-1394
Practice Address - Street 1:1397 WEIMER RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6253
Practice Address - Country:US
Practice Address - Phone:575-758-8883
Practice Address - Fax:303-468-1394
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE220472085R0202X
TXG52792085R0202X
CO280612085R0202X
NM84-2092085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025709000Medicaid
NEP00720336OtherRR MCR NE
WA0255069OtherDOL WASHINGTON
WA0259639OtherDOL WA RIN
WY1447247994Medicaid
SD1447247994/7726790Medicaid
NM000W6165Medicaid
NEE60792Medicare UPIN
SD1447247994/7726790Medicaid
NENA1214011Medicare PIN