Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 01058224A | IN |
NPI | 1023071107 |
---|---|
Provider Name | Daniel R Lamothe |
First Address | Edwards Afb, CA 93524-0001 |
Second Address | Edwards Afb, CA 93524-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 20/05/2021 |