Provider Demographics
NPI:1447257233
Name:LOTMAN, ALFRED C (MD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:C
Last Name:LOTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8380 ZUNI ST
Mailing Address - Street 2:#200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-4778
Mailing Address - Country:US
Mailing Address - Phone:303-428-9203
Mailing Address - Fax:303-430-8134
Practice Address - Street 1:8380 ZUNI ST
Practice Address - Street 2:#200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-4778
Practice Address - Country:US
Practice Address - Phone:303-428-9203
Practice Address - Fax:303-430-8134
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21240174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01212406Medicaid
COD23910Medicare UPIN
COU0418Medicare ID - Type Unspecified