Provider Demographics
NPI:1588724173
Name:LAMOTHE, COMOCHE (MD)
Entity type:Individual
Prefix:
First Name:COMOCHE
Middle Name:
Last Name:LAMOTHE
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 1:40 HELM DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-8347
Mailing Address - Country:US
Mailing Address - Phone:620-804-2066
Mailing Address - Fax:
Practice Address - Street 1:RURAL ROUTE 3
Practice Address - Street 2:BOX 89
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-9365
Practice Address - Country:US
Practice Address - Phone:620-804-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN5652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS08-00295OtherINSTITUTIONAL LICENSE NUM
106005OtherBCBS