Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 33117 | MN |
Y | 208600000X | Surgeon | 33117 | MN |
NPI | 1023097342 |
---|---|
Provider Name | Jeffrey Paul Lotts |
First Address | Albert Lea, MN 56007-1484 |
Second Address | Albert Lea, MN 56007-2437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E66181 | (02) |