Provider Demographics
NPI:1104882877
Name:SOTI, NOY (MD)
Entity type:Individual
Prefix:DR
First Name:NOY
Middle Name:
Last Name:SOTI
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 1:1790 BAHAMA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-3670
Mailing Address - Country:US
Mailing Address - Phone:928-399-0803
Mailing Address - Fax:
Practice Address - Street 1:394 NORTH CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:QUARTZSITE
Practice Address - State:AZ
Practice Address - Zip Code:85346
Practice Address - Country:US
Practice Address - Phone:928-927-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30059173000000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0738980OtherBCBS
AZ180044778OtherRRMEDICARE
AZC37641Medicare UPIN
AZZ68603Medicare PIN