Provider Demographics
NPI:1912924598
Name:MOTT, LEWIS JM (MD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:JM
Last Name:MOTT
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 1:18128 WOOD DUCK ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-6033
Mailing Address - Country:US
Mailing Address - Phone:530-666-7473
Mailing Address - Fax:
Practice Address - Street 1:18128 WOOD DUCK ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-6033
Practice Address - Country:US
Practice Address - Phone:530-666-7473
Practice Address - Fax:530-666-7473
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25617207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G256170OtherBLUE SHIELD
CA00G256170Medicaid
CAP00003480OtherRR MEDICARE
A42730Medicare UPIN
CA00G256170Medicaid